Provider Demographics
NPI:1144271073
Name:MARDINEY, MATTHEW PETER SR (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PETER
Last Name:MARDINEY
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1300 YORK RD
Mailing Address - Street 2:SUITE 30D
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6016
Mailing Address - Country:US
Mailing Address - Phone:443-519-2128
Mailing Address - Fax:443-557-6699
Practice Address - Street 1:2225 OLD EMMORTON RD
Practice Address - Street 2:SUITE 111
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6129
Practice Address - Country:US
Practice Address - Phone:443-987-6998
Practice Address - Fax:443-557-6699
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-09-16
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Provider Licenses
StateLicense IDTaxonomies
MDD0054372207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG02310M02Medicare PIN
MD168P400GMedicare PIN
010026032Medicare PIN
MDH83121Medicare UPIN