Provider Demographics
NPI:1629037171
Name:MARKIN, LAURIE SUSAN (MD)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:SUSAN
Last Name:MARKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:SUSAN
Other - Last Name:TELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5645 STONE RD
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1618
Mailing Address - Country:US
Mailing Address - Phone:703-266-2442
Mailing Address - Fax:703-266-7158
Practice Address - Street 1:5645 STONE RD
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1618
Practice Address - Country:US
Practice Address - Phone:703-266-2442
Practice Address - Fax:703-266-7158
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0181539OtherUNITED HEALTHCARE
VA5615712Medicaid
VA80940004OtherCAREFIRST
VA502653OtherNCPPO
VA288721OtherMAMSI
VA5565205OtherAETNA
VA383307OtherBCBS ANTHEM
VA746938OtherONE HEALTH PLAN
VA00A233R05Medicare ID - Type Unspecified
VA5615712Medicaid