Provider Demographics
NPI:1518107069
Name:OLDENDORF MEDICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:OLDENDORF MEDICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:OLDENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-435-1300
Mailing Address - Street 1:407 ALBANY SHAKER ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1902
Mailing Address - Country:US
Mailing Address - Phone:518-435-1300
Mailing Address - Fax:518-435-1397
Practice Address - Street 1:407 ALBANY SHAKER RD
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12211-1900
Practice Address - Country:US
Practice Address - Phone:518-435-1300
Practice Address - Fax:518-435-1397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty