Provider Demographics
NPI:1609827724
Name:MARDINEY, MICHAEL III (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MARDINEY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21041-0609
Mailing Address - Country:US
Mailing Address - Phone:410-461-4500
Mailing Address - Fax:410-461-4525
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
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043585207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD168P399GMedicare PIN
DCG02310M01Medicare PIN
MDF71254Medicare UPIN
010026032Medicare PIN
PA091553UAPMedicare PIN