Provider Demographics
NPI:1659384881
Name:HELLNER, MARK THOMAS (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:THOMAS
Last Name:HELLNER
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 1:900 W OLIVE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2429
Mailing Address - Country:US
Mailing Address - Phone:209-388-0730
Mailing Address - Fax:209-388-0731
Practice Address - Street 1:900 W OLIVE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2429
Practice Address - Country:US
Practice Address - Phone:209-388-0730
Practice Address - Fax:209-388-0731
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52055207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G520550Medicaid
CA00G520550Medicaid
CADC8142Medicare PIN
A52151Medicare UPIN