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NPI Code Detail

MEDICARE: MARK DIRNBERGER DO PA

MEDICARE: MARK DIRNBERGER DO 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
1208VP0000XPain Medicine PhysicianL5305TX
2204D00000XNeuromusculoskeletal Medicine & OMM PhysicianL5305TX

General Provider Information

NPI Number : 1801078753
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARK DIRNBERGER DO PA
Provider Business Mailing Address
First Line : 74 REGENCY PKWY
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-7816
Country : US
Telephone Number : 817-419-6111
Fax Number : 817-572-7982
Provider Business Practice Location Address
First Line : 2001 SE GREEN OAKS BLVD.
Second Line : SUITE # 130
City : ARLINGTON
State : TX
Zip : 76018-0952
Country : US
Telephone Number : 817-419-6111
Fax Number : 817-572-7982
Authorized Official
Title or Position : OWNER
Name : MARK A DIRNBERGER
Credential : MD
Telephone Number : 817-419-6111
Provider Enumeration Date : 12/03/2007
Last Update Date : 04/28/2022

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