Provider Demographics
NPI:1841366465
Name:DIRNBERGER, MARK A (DO,PA)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:DIRNBERGER
Suffix:
Gender:M
Credentials:DO,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 REGENCY PKWY
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7816
Mailing Address - Country:US
Mailing Address - Phone:817-419-6111
Mailing Address - Fax:817-419-9582
Practice Address - Street 1:74 REGENCY PKWY
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7816
Practice Address - Country:US
Practice Address - Phone:817-419-6000
Practice Address - Fax:817-419-9582
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5305208VP0000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H94571Medicare UPIN
609908Medicare ID - Type Unspecified