Provider Demographics
NPI:1538282512
Name:DENK, MARY WINIFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:WINIFRED
Last Name:DENK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:WINIFRED
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6136 BELLAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4407
Mailing Address - Country:US
Mailing Address - Phone:818-769-6378
Mailing Address - Fax:818-761-4321
Practice Address - Street 1:6136 BELLAIRE AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-4407
Practice Address - Country:US
Practice Address - Phone:818-769-6378
Practice Address - Fax:818-761-4321
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025567L2085R0001X
CAC295212085R0001X
KY347542085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD71401Medicare UPIN