Provider Demographics
NPI:1093909236
Name:ELKIN OBSTETRICS AND GYNECOLOGY, PLLC
Entity Type:Organization
Organization Name:ELKIN OBSTETRICS AND GYNECOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-835-2283
Mailing Address - Street 1:101 A ELDON PARKS DR.
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621
Mailing Address - Country:US
Mailing Address - Phone:336-835-2283
Mailing Address - Fax:336-835-1562
Practice Address - Street 1:101 A ELDON PARKS DR.
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621
Practice Address - Country:US
Practice Address - Phone:336-835-2283
Practice Address - Fax:336-835-1562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF82162Medicare UPIN