Provider Demographics
NPI:1114995727
Name:SCRIPPS, MARK L
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:SCRIPPS
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 1:1721 FINANCIAL LOOP
Mailing Address - Street 2:
Mailing Address - City:LAKE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2460
Mailing Address - Country:US
Mailing Address - Phone:703-491-9500
Mailing Address - Fax:
Practice Address - Street 1:1721 FINANCIAL LOOP
Practice Address - Street 2:
Practice Address - City:LAKE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2460
Practice Address - Country:US
Practice Address - Phone:703-491-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103001038213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9302905Medicaid
VAU69918Medicare UPIN
VA480000614Medicare ID - Type Unspecified