Provider Demographics
NPI:1346232014
Name:KING, MARK RODNEY (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RODNEY
Last Name:KING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 22245
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-9224
Mailing Address - Country:US
Mailing Address - Phone:703-212-4770
Mailing Address - Fax:703-212-4877
Practice Address - Street 1:2867 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4512
Practice Address - Country:US
Practice Address - Phone:703-212-4770
Practice Address - Fax:703-212-4877
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102050164207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010155622Medicaid
VA010155622Medicaid
VAF62882Medicare UPIN