MEDICARE: MICHAEL R MARDINEY JR MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician

General Provider Information

NPI Number	:	1023143138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL R MARDINEY JR MD PA

Provider Business Mailing Address
First Line	:	PO BOX 490
Second Line	:
City	:	RIDERWOOD
State	:	MD
Zip	:	21139-0490
Country	:	US
Telephone Number	:	410-461-7660
Fax Number	:

Provider Business Practice Location Address
First Line	:	3105 N RIDGE RD
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-3348
Country	:	US
Telephone Number	:	410-461-7660
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL RALPH MARDINEY JR.
Credential	:	MD
Telephone Number	:	410-461-7660

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/17/2008

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