Wallingford, Mark Allen

Wallingford, Mark Allen is an individual health care provider with primary practice located at 2009 Old Main Street , Maysville KY 41056. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Wallingford, Mark Allen can be contacted via phone (606) 759-7615.

Contact Information

Primary practice address
2009 Old Main Street Maysville KY 41056
Fax: (606) 759-7821
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 24430 Kentucky
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 24430 Kentucky

Profile Details

NPI number 1205919875
LBN Legal business name Wallingford, Mark Allen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 24th, 2006
Last updated Jan 30th, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205919875 NPPES
Kentucky MEDICAID 64244304

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