Active NPI
Mark J Bates, PHD
- Clinical Psychologist
- Andrews AFB, MD
National Provider Identifier
1679663124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1296
- Practice address
- 1050 W. Perimeter Rd
Malcolm Grow Medical Center
Andrews AFB, MD 20762 - Phone
- (240) 867-9940
- NPI assigned
- Oct 13, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1296 | AL | Primary |
Addresses
Primary practice location
1050 W. Perimeter Rd
Malcolm Grow Medical Center
Andrews AFB, MD 20762
Mailing address
1050 W. Perimeter Rd
Malcolm Grow Medical Center
Andrews AFB, MD 20762
Phone (240) 867-9940
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1296 | AL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679663124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1050 W. PERIMETER RD",
"address_2": "MALCOLM GROW MEDICAL CENTER",
"city": "ANDREWS AFB",
"state": "MD",
"postal_code": "20762",
"telephone_number": "240-867-9940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 W. PERIMETER RD",
"address_2": "MALCOLM GROW MEDICAL CENTER",
"city": "ANDREWS AFB",
"state": "MD",
"postal_code": "20762",
"telephone_number": "240-867-9940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BATES",
"first_name": "MARK",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AL",
"license": "1296",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Andrews AFB, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.