Provider Demographics
NPI:1477586972
Name:XENAKIS, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:XENAKIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13572 WATERFORD PL
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3928
Mailing Address - Country:US
Mailing Address - Phone:804-560-8782
Mailing Address - Fax:804-288-6591
Practice Address - Street 1:13572 WATERFORD PL
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3928
Practice Address - Country:US
Practice Address - Phone:804-560-8782
Practice Address - Fax:804-288-6591
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234821207RI0011X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3236966OtherAETNA
VA8689624OtherCIGNA
VA010028302Medicaid
VAP00084989OtherRAILROAD MEDICARE
VA2108911OtherUNITED HEALTHCARE
VA010028302Medicaid
VAH90748Medicare UPIN
VA010028302Medicaid