Provider Demographics
NPI:1437138328
Name:PINKERTON, MARK DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:PINKERTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:251 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CEDARVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45314-8501
Mailing Address - Country:US
Mailing Address - Phone:937-766-7417
Mailing Address - Fax:937-766-7865
Practice Address - Street 1:251 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDARVILLE
Practice Address - State:OH
Practice Address - Zip Code:45314-8501
Practice Address - Country:US
Practice Address - Phone:937-766-7417
Practice Address - Fax:937-766-7865
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33488207Q00000X
OH35063921207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01334887Medicaid
OH3144912Medicaid
OH3144912Medicaid
OH4320081Medicare PIN
OH4320081Medicare PIN