Mark T. Fahlen, MD, Inc. a Professional Medical Corporation

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

A81212 Issued in CA

Legal business name

MARK T. FAHLEN, MD, INC. A PROFESSIONAL MEDICAL CORPORATION

Practice address

1400 Florida Ave
Suite 109
Modesto, CA 95350-4422

Phone

(209) 544-2910

Fax

(209) 544-2253

NPI assigned

Aug 3, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark Theodore Fahlen, M.D.NPI 1679539415

Title

President

Phone

(209) 544-2910

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/1735/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark T Fahlen, MD

  • Nephrology Physician
  • Modesto, CA
  • NPI 1679539415
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312243200000",
    "number": "1659537264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 FLORIDA AVE",
            "address_2": "SUITE 109",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504422",
            "telephone_number": "209-544-2910",
            "fax_number": "209-544-2253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 FLORIDA AVE",
            "address_2": "SUITE 109",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504422",
            "telephone_number": "209-544-2910",
            "fax_number": "209-544-2253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK T. FAHLEN, MD, INC. A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-03",
        "last_updated": "2011-08-02",
        "status": "A",
        "authorized_official_last_name": "FAHLEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "THEODORE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-544-2910",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A81212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dyanne Mariscal
• Gema Mariscal
• Nayeli Mariscal
• Nohemi Mariscal
• Mark H. Harder OD
• Arletha Vondell Mark
• Janel Mark
• Timothy Markham
• Breanne L. Markowitz, DNP, PMHNP-BC, RN
• Markus Jackson MD Inc

• Nephrology Physician in Modesto, CA
• Providers in Modesto, CA by specialty
• Nephrology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.