Provider Demographics
NPI:1891093878
Name:VESNA MRZLJAK MD, PC
Entity type:Organization
Organization Name:VESNA MRZLJAK MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-751-6060
Mailing Address - Street 1:6300 STEVENSON AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3576
Mailing Address - Country:US
Mailing Address - Phone:703-751-6060
Mailing Address - Fax:703-751-6870
Practice Address - Street 1:6300 STEVENSON AVE
Practice Address - Street 2:UNIT A
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3576
Practice Address - Country:US
Practice Address - Phone:703-751-6060
Practice Address - Fax:703-751-6870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035385174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB94920Medicare UPIN
VA432096Medicare PIN