Provider Demographics
NPI:1124022843
Name:JANCZEWSKI, MARK GEORGE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:GEORGE
Last Name:JANCZEWSKI
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3438 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1266
Mailing Address - Country:US
Mailing Address - Phone:703-698-5811
Mailing Address - Fax:
Practice Address - Street 1:3438 HOLLY RD
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1266
Practice Address - Country:US
Practice Address - Phone:703-698-5811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041106207Q00000X, 2083A0100X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine