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General NPI Number Information
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NPI Number | 1427147800
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Entity Type | Individual
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Provider Name | MARK OLDENDORF MD
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 02/07/2019
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Provider Practice Location Address
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Address Line | 407 ALBANY SHAKER RD STE 100
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City | LOUDONVILLE
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State | NY
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Zip | 12211-1902
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Country | US
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Telephone | 518-435-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 407 ALBANY SHAKER RD
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City | LOUDONVILLE
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State | NY
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Zip | 12211-1900
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Country | US
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Telephone | 518-435-1300
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Fax | 518-435-1397
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 146168
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 146168
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License Number State | NY
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