Provider Demographics
NPI:1174760235
Name:GRAMLING, MARK EVAN
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:EVAN
Last Name:GRAMLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6112 ZACHARY TAYLOR HWY
Mailing Address - Street 2:
Mailing Address - City:MINERAL
Mailing Address - State:VA
Mailing Address - Zip Code:23117-5036
Mailing Address - Country:US
Mailing Address - Phone:540-854-4282
Mailing Address - Fax:540-854-4282
Practice Address - Street 1:6112 ZACHARY TAYLOR HWY
Practice Address - Street 2:
Practice Address - City:MINERAL
Practice Address - State:VA
Practice Address - Zip Code:23117-5036
Practice Address - Country:US
Practice Address - Phone:540-854-4282
Practice Address - Fax:540-854-4282
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2705034314171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications