Provider Demographics
NPI:1043234552
Name:ROCKY RUN FAMILY MEDICINE INC
Entity Type:Organization
Organization Name:ROCKY RUN FAMILY MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:MARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-266-2442
Mailing Address - Street 1:5645 STONE RD
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1618
Mailing Address - Country:US
Mailing Address - Phone:703-266-2442
Mailing Address - Fax:703-266-7158
Practice Address - Street 1:5645 STONE RD
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1618
Practice Address - Country:US
Practice Address - Phone:703-266-2442
Practice Address - Fax:703-266-7158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA144870173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA383306OtherANTHEM BC/BS
VA5615691Medicaid
VA8094-0001OtherCAREFIRST
VA5615712Medicaid
VA8094-0004OtherCAREFIRST
VA383307OtherANTHEM BC/BS
VA8094-0002OtherCAREFIRST
VA383308OtherANTHEM BC/BS
VA5615747Medicaid
VAE76015Medicare UPIN
VA5615747Medicaid
VAG28253Medicare UPIN
VA00A232R05Medicare ID - Type Unspecified
VA00A234R05Medicare ID - Type Unspecified
VA00A233R05Medicare ID - Type Unspecified