Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | D0054372 | MD |
NPI | 1144271073 |
---|---|
Provider Name | Dr. Matthew Peter Mardiney SR. |
First Address | Lutherville, MD 21093-6016 |
Second Address | Bel Air, MD 21015-6129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 16/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H83121 | (02) | MD |