Healthcare Provider Details

I. General information

NPI: 1740254556
Provider Name (Legal Business Name): MARK ALDEN HARRINGTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 S PATRICK DR
PATRICK AFB FL
32925-3606
US

IV. Provider business mailing address

1381 S PATRICK DR
PATRICK AFB FL
32925-3606
US

V. Phone/Fax

Practice location:
  • Phone: 321-494-8241
  • Fax: 630-570-6072
Mailing address:
  • Phone: 321-494-8241
  • Fax: 630-570-6072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA145708
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A10683
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO170187
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: