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
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