Provider Demographics
NPI:1669674818
Name:NARDUZZI, MARK DAVID (IDC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:NARDUZZI
Suffix:
Gender:M
Credentials:IDC
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Other - Credentials:
Mailing Address - Street 1:5722 INTEGRITY DR
Mailing Address - Street 2:BLDG S-771
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38054-5028
Mailing Address - Country:US
Mailing Address - Phone:901-874-6100
Mailing Address - Fax:901-874-6104
Practice Address - Street 1:5722 INTEGRITY DR
Practice Address - Street 2:BLDG S-771
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38054-5028
Practice Address - Country:US
Practice Address - Phone:901-874-6100
Practice Address - Fax:901-874-6104
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians