Individual
MARK D RADER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
144 5TH AVE, HYNDMAN, PA 15545-7379
(814) 842-3206
Mailing address
PO BOX 457, SAGE MEMORIAL HOSPITAL, GANADO, AZ 86505-0457
(928) 755-4500
(928) 755-4659
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD012147E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000699472
—
PA
01
—
60680733
MEDICAID
NM
05
—
821430
—
AZ
Enumeration date
10/17/2005
Last updated
01/18/2019
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