Provider Demographics
NPI:1386613826
Name:TEKRONY, MARK C (PHD, MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:TEKRONY
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3020 HAMAKER CT
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2238
Mailing Address - Country:US
Mailing Address - Phone:703-876-0800
Mailing Address - Fax:703-876-0866
Practice Address - Street 1:1830 TOWN CENTER DR STE 305
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3217
Practice Address - Country:US
Practice Address - Phone:703-876-0800
Practice Address - Fax:703-876-0866
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012326132084N0008X, 2084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010064414Medicaid
VA010064414Medicaid
VA013516N42Medicare PIN