Provider Demographics
NPI:1700026036
Name:MARDIROSSIAN, VARTAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VARTAN
Middle Name:
Last Name:MARDIROSSIAN
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 1:1401 CHAIN BRIDGE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3883
Mailing Address - Country:US
Mailing Address - Phone:703-260-8291
Mailing Address - Fax:
Practice Address - Street 1:1401 CHAIN BRIDGE RD STE 201
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3883
Practice Address - Country:US
Practice Address - Phone:703-260-8291
Practice Address - Fax:703-691-5002
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115959207YS0123X
MDD0095977207YX0007X
VA0101269500207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery