Provider Demographics
NPI:1790899805
Name:VINER, MARK W (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:VINER
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 1:145 ISIDOR CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89441-6304
Mailing Address - Country:US
Mailing Address - Phone:775-772-6015
Mailing Address - Fax:
Practice Address - Street 1:145 ISIDOR CT
Practice Address - Street 2:SUITE A
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89441-6304
Practice Address - Country:US
Practice Address - Phone:775-772-6015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV69832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1497080956OtherNPI TYPE 2 ORGANIZATIONAL
NV1497080956OtherNPI TYPE 2 ORGANIZATIONAL
F67755Medicare UPIN