Provider Demographics
NPI:1083670731
Name:ALDAPE, MARK ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:ALDAPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1049
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0050
Mailing Address - Country:US
Mailing Address - Phone:541-966-1184
Mailing Address - Fax:541-278-9365
Practice Address - Street 1:700 SUNSET DR
Practice Address - Street 2:SUITE A
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1260
Practice Address - Country:US
Practice Address - Phone:541-963-8911
Practice Address - Fax:541-962-7110
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18908207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
220024158OtherRR MEDICARE
OR092798Medicaid
220024158OtherRR MEDICARE