Provider Demographics
NPI:1811970502
Name:WAINWRIGHT, MARK A (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:WAINWRIGHT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-864-1472
Mailing Address - Fax:270-864-1693
Practice Address - Street 1:279 KING'S DAUGHTERS DR
Practice Address - Street 2:STE 301
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4324
Practice Address - Country:US
Practice Address - Phone:502-227-2229
Practice Address - Fax:502-227-1114
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02677207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64036593Medicaid
KY64036593Medicaid
KYK083000Medicare PIN
KY0613005Medicare PIN
KY160058243Medicare PIN
KY0000000232483OtherANTHEM PIN
KYG90143Medicare UPIN
KY0612905Medicare PIN