Active NPI
Mark Roy Zemanovich, DDS, MS
- Periodontics
- Stephens City, VA
National Provider Identifier
1649372293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 0401411115
- Practice address
- 203 Salem Church Rd
Stephens City, VA 22655-5314 - Phone
- (540) 868-2740
- NPI assigned
- Sep 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 0401411115 | VA | Primary |
Addresses
Primary practice location
203 Salem Church Rd
Stephens City, VA 22655-5314
Mailing address
203 Salem Church Rd
Stephens City, VA 22655-5314
Phone (540) 868-2740
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0401411115 | Other | VA | DENTAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150511002410 | VA | Order and Referring Only - Oral Surgery | 2466771563 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401411115 | VA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1649372293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "203 SALEM CHURCH RD",
"city": "STEPHENS CITY",
"state": "VA",
"postal_code": "226555314",
"telephone_number": "540-868-2740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "203 SALEM CHURCH RD",
"city": "STEPHENS CITY",
"state": "VA",
"postal_code": "226555314",
"telephone_number": "540-868-2740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZEMANOVICH",
"first_name": "MARK",
"middle_name": "ROY",
"name_prefix": "Dr.",
"credential": "DDS, MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "VA",
"license": "0401411115",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE",
"identifier": "0401411115",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stephens City, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.