Mark Emanuel Vasiliadis, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0101050406 Issued in VA

Practice address

12040 S Lakes Dr
Suite 195
Reston, VA 20191-1246

Phone

(703) 230-0347

NPI assigned

Nov 14, 2006

Last updated

Aug 25, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2013 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mark.vasiliadis@105592283987972.direct.elationemr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Executive Healthcare Services PLLC

  • Family Medicine Physician
  • Reston, VA
  • NPI 1760664007
  NPD
• Generations Family Medicine PC

  dba Generations Family Practice

  • Family Medicine Physician
  • Reston, VA
  • NPI 1124239470
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661385600000",
    "number": "1639241771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12040 S LAKES DR STE 204",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201911236",
            "telephone_number": "703-230-0347",
            "fax_number": "703-230-0350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12040 S LAKES DR",
            "address_2": "SUITE 195",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201911246",
            "telephone_number": "703-230-0347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASILIADIS",
        "first_name": "MARK",
        "middle_name": "EMANUEL",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101050406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "593776473",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emil Frank Valle, M.D.
• Abigail F Vandivier, LPC
• Peter H. Vangeertruyden, MD
• Supriya Varma, M.D., F.A.C.O.G.
• Vascular Associates of Northern Virginia PC
• Barry Vassar
• Jayne Vecchio
• Kelly H. Veenstra, MS CCC-SLP
• Advika Venkatesh
• Monica Mary Vickers, LPTA

• Family Medicine Physician in Reston, VA
• Providers in Reston, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.