MEDICARE: DR. MARK OLDENDORF MD

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	207QA0505X	Adult Medicine Physician	146168	NY
2	207R00000X	Internal Medicine Physician	146168	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427147800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK OLDENDORF MD

Provider Business Mailing Address
First Line	:	407 ALBANY SHAKER RD
Second Line	:
City	:	LOUDONVILLE
State	:	NY
Zip	:	12211-1900
Country	:	US
Telephone Number	:	518-435-1300
Fax Number	:	518-435-1397

Provider Business Practice Location Address
First Line	:	407 ALBANY SHAKER RD STE 100
Second Line	:
City	:	LOUDONVILLE
State	:	NY
Zip	:	12211-1902
Country	:	US
Telephone Number	:	518-435-1300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	02/07/2019

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