Organization
MAYSVILLE INTERNAL MEDICINE PEDIATRIC ASSOC PSC
Active
Organization
MAYSVILLE INTERNAL MEDICINE PEDIATRIC ASSOC PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ALLEN WALLINGFORD MD (PRESIDENT)
(606) 759-7615
Entity
Organization
Contact information
Practice address
2009 OLD MAIN ST, MAYSVILLE, KY 41056
(606) 759-7615
(606) 759-7821
Mailing address
2009 OLD MAIN ST, MAYSVILLE, KY 41056
(606) 759-7615
(606) 759-7821
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
24430
KY
208000000X
Pediatrics Physician
—
KY
363LF0000X
Family Nurse Practitioner
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65933012
—
KY
05
—
7100379280
—
KY
01
—
C78288
DR WALLINGFORDS UPIN
—
Enumeration date
10/24/2006
Last updated
06/09/2016
Update your record
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