Basic Information
| Provider Information | |||||||||
| NPI: | 1740254556 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRINGTON | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | ALDEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8100 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973030900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033992424 | ||||||||
| FaxNumber: | 5033757429 | ||||||||
| Practice Location | |||||||||
| Address1: | 2531 BOONE RD SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973069675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033992424 | ||||||||
| FaxNumber: | 5033757429 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 07/13/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A10683 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | A145708 | NM | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DO170187 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 500680570 | 05 | OR | MEDICAID |