Provider Demographics
NPI:1619943529
Name:ZOLNICK, MARK RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RICHARD
Last Name:ZOLNICK
Suffix:
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 1:502 ELM ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2512
Mailing Address - Country:US
Mailing Address - Phone:505-841-1000
Mailing Address - Fax:505-843-2956
Practice Address - Street 1:2085 S PACHECO ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6103
Practice Address - Country:US
Practice Address - Phone:505-984-8012
Practice Address - Fax:505-984-1567
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003107207RC0000X
NMMD2008-0590207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000179301Medicaid
DE0000179301Medicaid
NMNM300762Medicare PIN
B66601Medicare UPIN