Provider Demographics
NPI:1235258971
Name:MCKINNON, MARK FRANCIS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:FRANCIS
Last Name:MCKINNON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7021 DASHER FARM CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-8207
Mailing Address - Country:US
Mailing Address - Phone:608-215-2455
Mailing Address - Fax:
Practice Address - Street 1:7021 DASHER FARM CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-8207
Practice Address - Country:US
Practice Address - Phone:608-215-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030474363A00000X
WI1718-023363A00000X
MDC0003412363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant