Provider Demographics
NPI:1093430159
Name:KERLIN, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:KERLIN
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 1:9552 CANNONEER CT APT 203
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-7087
Mailing Address - Country:US
Mailing Address - Phone:501-749-2800
Mailing Address - Fax:
Practice Address - Street 1:6355 WALKER LN STE 512
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3251
Practice Address - Country:US
Practice Address - Phone:703-647-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program