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General NPI Number Information
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NPI Number | 1396278891
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Entity Type | Individual
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Provider Name | MARK AHLENIUS MD
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Gender | Male
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 9040 A JACKSON AVE MADIGAN ARMY MEDICAL CENTER
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City | JOINT BASE LEWIS MCCHORD
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State | WA
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Zip | 98431-4504
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Country | US
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Telephone | 253-968-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 3551 ROGER BROOKE DR SAN ANTONIO MILITARY MEDICAL CENTER, PEDIATRIC RESIDENC
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City | SAN ANTONIO
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone | 210-916-3160
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0101266050
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License Number State | VA
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