Provider Demographics
NPI:1922249721
Name:MACEDON, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:MACEDON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:125 HOSPITAL CENTER BLVD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-6202
Mailing Address - Country:US
Mailing Address - Phone:540-741-0655
Mailing Address - Fax:540-741-0657
Practice Address - Street 1:125 HOSPITAL CENTER BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-6202
Practice Address - Country:US
Practice Address - Phone:540-741-0655
Practice Address - Fax:540-741-0657
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2013-11-05
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Provider Licenses
StateLicense IDTaxonomies
VA01012486942085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology