Provider Demographics
NPI:1154571172
Name:MARDINI & ASSOCIATES MD, PSC
Entity type:Organization
Organization Name:MARDINI & ASSOCIATES MD, PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / CHIEF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOUSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARDINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-684-6964
Mailing Address - Street 1:PO BOX 1686
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1686
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:613 23RD ST
Practice Address - Street 2:SUITE 120
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2878
Practice Address - Country:US
Practice Address - Phone:859-684-6964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty