Provider Demographics
NPI:1346265766
Name:ADLARD, MARK EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:ADLARD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:22342 AVENIDA EMPRESA
Mailing Address - Street 2:SUITE 195
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2140
Mailing Address - Country:US
Mailing Address - Phone:949-858-7001
Mailing Address - Fax:949-858-3826
Practice Address - Street 1:22342 AVENIDA EMPRESA
Practice Address - Street 2:SUITE 195
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2140
Practice Address - Country:US
Practice Address - Phone:949-858-7001
Practice Address - Fax:949-858-3826
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG64159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330488458OtherTAX ID
CAZZZ35743ZOtherBLUE SHIELD OF CA
CAG64159OtherMEDICAL LICENSE CA
CAZZZ35743ZOtherBLUE SHIELD OF CA
CAG64159Medicare ID - Type Unspecified