Provider Demographics
NPI:1881652329
Name:BARTOLOZZI, MARK ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:BARTOLOZZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:703-257-9234
Mailing Address - Fax:703-257-1560
Practice Address - Street 1:9001 DIGGES RD
Practice Address - Street 2:STE 204
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110
Practice Address - Country:US
Practice Address - Phone:703-257-9234
Practice Address - Fax:703-257-1560
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048180208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1881652329Medicaid
VA4235092OtherAETNA
VA290719OtherANTHEM
VA7306105Medicaid
VAVV5043AMedicare PIN
VA4235092OtherAETNA
VA290719OtherANTHEM