Provider Demographics
NPI:1669532263
Name:MARK D MILITANA MD PC
Entity type:Organization
Organization Name:MARK D MILITANA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-282-9133
Mailing Address - Street 1:110 N ROBINSON ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4459
Mailing Address - Country:US
Mailing Address - Phone:804-780-2610
Mailing Address - Fax:804-649-1041
Practice Address - Street 1:110 N ROBINSON ST
Practice Address - Street 2:SUITE 305
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4459
Practice Address - Country:US
Practice Address - Phone:804-780-2610
Practice Address - Fax:804-649-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherFEDERAL TAX ID