MR. MARK EMANUEL VASILIADIS (NPI# 1639241771) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639241771 |
| Entity Type | Individual |
| Full Name | MR. MARK EMANUEL VASILIADIS |
| Credential | M.D. |
| Practice Address |
12040 S Lakes Dr Suite 195 Reston VA 20191-1246 |
| Mailing Address |
909 Challedon Rd Great Falls VA 22066-1727 |
| Practice Telephone | 7032300347 |
| Mailing Telephone | 7037597717 |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2010-10-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 0101050406 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | TAX ID | 593776473 | 01 |
| Street Address |
12040 S LAKES DR SUITE 195 |
| City | RESTON |
| State | VA |
| Zip Code | 20191-1246 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689674202 | Kevin J Kelleher | Family Medicine | 12040 S Lakes Dr, Ste 207, Reston, VA 20191-1246 | 2005-07-26 |
| 1760938161 | Laura Lisbeth Kennedy | Registered Nurse | 12040 S Lakes Dr, Reston, VA 20191-1246 | 2016-08-27 |
| 1528386224 | Ehs Corporate Care | Internal Medicine | 12040 S Lakes Dr, Suite 205, Reston, VA 20191-1246 | 2010-05-06 |
| 1831423144 | Aramesh Darvishian Dds | Dentist | 12040 S Lakes Dr, Suite 200, Reston, VA 20191-1246 | 2009-09-21 |
| 1760664007 | Executive Healthcare Services Pllc | Family Medicine | 12040 S Lakes Dr, Suite 195, Reston, VA 20191 | 2007-11-28 |
| 1821279381 | Deanna Lynn Markley | Physician Assistant | 12040 S Lakes Dr, Suite 207, Reston, VA 20191-1246 | 2007-11-26 |
| 1952502056 | Mary Elizabeth Mcgrath | Family Medicine | 12040 S Lakes Dr, Ste 190, Reston, VA 20191-1245 | 2007-05-29 |
| 1124239470 | Generations Family Medicine PC | Family Medicine | 12040 S Lakes Dr, Ste 190, Reston, VA 20191-1246 | 2007-05-25 |
| 1942418876 | Robin Susan Cohen | Social Worker | 12040 S Lakes Dr, Suite 204, Reston, VA 20191-1246 | 2007-05-21 |
| 1902998552 | Mina Garrett-scott | Family Medicine | 12040 S Lakes Dr, Suite 207, Reston, VA 20191-1246 | 2006-09-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275150518 | Grace Andales Soistman | Nurse Practitioner | 11160 South Lakes Dr. Reston, Va 20191, Reston, VA 20191 | 2020-07-02 |
| 1790317709 | Twenty Four/7 LLC | Private Vehicle | 11922 Winterthur Ln, 103, Reston, VA 20191 | 2020-02-07 |
| 1437626058 | Aramesh Darvishian Dds Pllc | Dentist | 12040 South Lakes Dr. Suite 200, Reston, VA 20191 | 2018-11-01 |
| 1992282693 | Ashkan Ghods | Home Health | 11760 Sunrise Valley Dr, #405, Reston, VA 20191 | 2018-07-25 |
| 1104319698 | Capital Critical Care & Informatics PC | Internal Medicine | 11890 Sunrise Valley Dr # 442, Reston, VA 20191 | 2018-06-11 |
| 1063930683 | Mackenzie Marie Evans | Specialist/Technologist | 2380 Branleigh Park Ct, Reston, VA 20191 | 2017-09-04 |
| 1073910345 | Jane L Mahan-wiegand | Dietitian, Registered | 1900 Campus Commons Drive, Suite 100, Reston, VA 20191 | 2014-12-02 |
| 1700214293 | Sonny Sunghun Kim | Dentist | 11876 Sunrise Valley Drive, 101, Reston, VA 20191 | 2013-10-22 |
| 1982036786 | Stephanie Lourdes Miller | Physician Assistant | 12040 South Lakes Drive, Suite 207, Generations Family Practice, Reston, VA 20191 | 2013-08-02 |
| 1316250988 | Thao Ngoc Vuong | Pharmacist | 1898 Winterport Cluster, Reston, VA 20191 | 2010-07-23 |
| Find all providers in zip 20191 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366729675 | Eric S. Havens P L L C | Family Medicine | 1850 Town Center Pkwy Ste 207, Reston, VA 20190-3219 | 2011-11-15 |
| 1396961025 | Eric S Havens | Family Medicine | 1850 Town Center Pkwy # 207, Reston, VA 20190-3219 | 2007-04-18 |
| 1619036597 | Michael G Bowers | Family Medicine | 12110 Sunset Hills Road, Ll20, Reston, VA 20190 | 2006-12-07 |
| 1295742419 | Thomas S Sullivan | Family Medicine | 12018 Sunrise Valley Dr, Suite 400, Reston, VA 20191-3432 | 2006-08-01 |
| 1699769745 | Andrew J Harding | Family Medicine | 11800 Sunrise Valley Dr, Suite 700, Reston, VA 20191-5300 | 2005-09-06 |
| 1689674202 | Kevin J Kelleher | Family Medicine | 12040 S Lakes Dr, Ste 207, Reston, VA 20191-1246 | 2005-07-26 |
| 1548268857 | Allen Kinne Howe Jr. | Family Medicine | 12330 Pinecrest Rd, Suite 250, Reston, VA 20191-1642 | 2005-07-11 |
| 1023618261 | Kelly Hernandez | Family Medicine | 12330 Pinecrest Rd Ste 250, Reston, VA 20191-1657 | 2020-10-27 |
| 1649893793 | Nova Primary Care LLC | Family Medicine | 1860 Town Center Dr Ste 340, Reston, VA 20190-5912 | 2020-05-24 |
| 1871975235 | Christopher John Thomas | Family Medicine | 1890 Metro Center Dr, Reston, VA 20190-5286 | 2015-06-22 |
| Find all providers in RESTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.