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NPI Code Detail

MEDICARE: OLDENDORF MEDICAL SERVICES, PLLC

MEDICARE: OLDENDORF MEDICAL SERVICES, PLLC
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
1261QM1300XMulti-Specialty Clinic/Center
2207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1518107069
Entity Type Code : Organization
Provider Name (Legal Business Name) : OLDENDORF MEDICAL SERVICES, PLLC
Provider Business Mailing Address
First Line : 407 ALBANY SHAKER ROAD
Second Line : SUITE 100
City : LOUDONVILLE
State : NY
Zip : 12211-1902
Country : US
Telephone Number : 518-435-1300
Fax Number : 518-435-1397
Provider Business Practice Location 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
Authorized Official
Title or Position : MD/OWNER
Name : DR. MARK OLDENDORF
Credential : MD
Telephone Number : 518-435-1300
Provider Enumeration Date : 02/24/2009
Last Update Date : 08/08/2019

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