Provider Demographics
NPI:1508835703
Name:WISH, MARC (MD, FACC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:WISH
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 HAMAKER CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2238
Mailing Address - Country:US
Mailing Address - Phone:703-289-9400
Mailing Address - Fax:703-289-9404
Practice Address - Street 1:3020 HAMAKER CT
Practice Address - Street 2:SUITE 101
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2238
Practice Address - Country:US
Practice Address - Phone:703-289-9400
Practice Address - Fax:703-289-9404
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034890207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006074286Medicaid
VAD09665Medicare UPIN
VA634678Medicare ID - Type Unspecified