Provider Demographics
NPI:1447366349
Name:LANDAU, MARK EVAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EVAN
Last Name:LANDAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MARYLAND FARMS STE 200
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5780
Mailing Address - Country:US
Mailing Address - Phone:800-348-4565
Mailing Address - Fax:888-203-4247
Practice Address - Street 1:1331 AUWAIKU ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4106
Practice Address - Country:US
Practice Address - Phone:800-348-4565
Practice Address - Fax:888-203-4247
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00658952084N0400X
FLME1535652084N0400X
NMMD2021-04472084N0400X
VA485562084N0600X
HIMD-105422084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology