Provider Demographics
NPI:1285792978
Name:GARABEDIAN, MARK C
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:GARABEDIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6372 MECHANICSVILLE TPKE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4705
Mailing Address - Country:US
Mailing Address - Phone:804-730-4690
Mailing Address - Fax:804-559-0333
Practice Address - Street 1:6372 MECHANICSVILLE TPKE
Practice Address - Street 2:SUITE 103
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4705
Practice Address - Country:US
Practice Address - Phone:804-730-4690
Practice Address - Fax:804-559-0333
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1892751208000000X
VA0101245096208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01443329Medicaid
VAC06115OtherGROUP PTAN
VAC06193OtherGROUP PTAN
VAC06115OtherGROUP PTAN