Provider Demographics
NPI:1205911849
Name:MARTINDALE, MARK A (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:MARTINDALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:105 MCNEIL ST
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3345
Mailing Address - Country:US
Mailing Address - Phone:501-315-1222
Mailing Address - Fax:501-315-1222
Practice Address - Street 1:5 MEDICAL PARK DR
Practice Address - Street 2:SUITE 102A
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3729
Practice Address - Country:US
Practice Address - Phone:501-315-1222
Practice Address - Fax:501-315-1222
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC7310207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR119185001Medicaid
AR119185001Medicaid
AR54606Medicare ID - Type UnspecifiedMEDICARE