Healthcare Provider Details

I. General information

NPI: 1871912741
Provider Name (Legal Business Name): CHRISTOPHER MARDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 11/18/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WELCH RD STE 325
PALO ALTO CA
94304-1510
US

IV. Provider business mailing address

4910 MUELLER BLVD SUITE 102
AUSTIN TX
78723
US

V. Phone/Fax

Practice location:
  • Phone: 650-721-6849
  • Fax:
Mailing address:
  • Phone: 512-777-2917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberT0851
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: