Provider Demographics
NPI:1841405370
Name:AMONETTE, MARK STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:AMONETTE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3921 FIGHTING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-7040
Mailing Address - Country:US
Mailing Address - Phone:804-598-0626
Mailing Address - Fax:
Practice Address - Street 1:3600 WOODS WAY
Practice Address - Street 2:
Practice Address - City:STATE FARM
Practice Address - State:VA
Practice Address - Zip Code:23160-0002
Practice Address - Country:US
Practice Address - Phone:804-598-4251
Practice Address - Fax:804-403-3495
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101041647207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine