Provider Demographics
NPI:1518977263
Name:MRZLJAK, VESNA (MD)
Entity Type:Individual
Prefix:
First Name:VESNA
Middle Name:
Last Name:MRZLJAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 STEVENSON AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3576
Mailing Address - Country:US
Mailing Address - Phone:703-751-6060
Mailing Address - Fax:703-751-6870
Practice Address - Street 1:6300 STEVENSON AVE
Practice Address - Street 2:UNIT A
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3576
Practice Address - Country:US
Practice Address - Phone:703-751-6060
Practice Address - Fax:703-751-6870
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035385207Y00000X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA432096Medicare PIN
VAB94920Medicare UPIN