Provider Demographics
NPI:1407239510
Name:MICHAEL MARDINEY, III, M.D. P.A.
Entity Type:Organization
Organization Name:MICHAEL MARDINEY, III, M.D. P.A.
Other - Org Name:MARDINEY ASTHMA, ALLERGY AND IMMUNOLOGY CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARDINEY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:410-377-6638
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:RIDERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21139-0490
Mailing Address - Country:US
Mailing Address - Phone:410-377-6638
Mailing Address - Fax:410-377-4892
Practice Address - Street 1:3105 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3348
Practice Address - Country:US
Practice Address - Phone:410-461-7660
Practice Address - Fax:410-461-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty