Provider Demographics
NPI:1629128947
Name:MARK, ANTHONY LEARY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:LEARY
Last Name:MARK
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 1:10 SHEFFIELD MANOR CT
Mailing Address - Street 2:APT 203
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7708
Mailing Address - Country:US
Mailing Address - Phone:202-782-6542
Mailing Address - Fax:
Practice Address - Street 1:6900 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20703
Practice Address - Country:US
Practice Address - Phone:202-782-6542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244571208600000X
DC390200000X208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery