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General NPI Number Information
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NPI Number | 1174881098
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Entity Type | Organization
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Legal Business Name | MATTHEW P MARDINEY MD PC
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Dates
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Enumeration Date | 04/28/2012
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 2225 OLD EMMORTON RD SUITE 111
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City | BEL AIR
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State | MD
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Zip | 21015-6129
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Country | US
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Telephone | 443-857-9829
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 813
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City | BEL AIR
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State | MD
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Zip | 21014-0813
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Country | US
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Telephone | 443-857-9829
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTHEW P MARDINEY
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Credential | MD
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Telephone | 443-857-9829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | D0054372
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License Number State | MD
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