Healthcare Provider Details

I. General information

NPI: 1801078753
Provider Name (Legal Business Name): MARK DIRNBERGER DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 04/28/2022
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SE GREEN OAKS BLVD. SUITE # 130
ARLINGTON TX
76018-0952
US

IV. Provider business mailing address

74 REGENCY PKWY
MANSFIELD TX
76063-7816
US

V. Phone/Fax

Practice location:
  • Phone: 817-419-6111
  • Fax: 817-572-7982
Mailing address:
  • Phone: 817-419-6111
  • Fax: 817-572-7982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberL5305
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberL5305
License Number StateTX

VIII. Authorized Official

Name: MARK A DIRNBERGER
Title or Position: OWNER
Credential: MD
Phone: 817-419-6111