Provider Demographics
NPI:1194728469
Name:PFAFF, MARK
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:PFAFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21922-0190
Mailing Address - Country:US
Mailing Address - Phone:410-398-4679
Mailing Address - Fax:410-620-3686
Practice Address - Street 1:160 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5538
Practice Address - Country:US
Practice Address - Phone:410-996-8686
Practice Address - Fax:410-398-8997
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2334624174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD147P355GMedicare PIN