Provider Demographics
NPI:1134111719
Name:KIEFER, MARK LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEWIS
Last Name:KIEFER
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 1:1531 N ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-7268
Mailing Address - Country:US
Mailing Address - Phone:704-732-8736
Mailing Address - Fax:704-732-8121
Practice Address - Street 1:1531 N ASPEN ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-7268
Practice Address - Country:US
Practice Address - Phone:704-732-8736
Practice Address - Fax:704-732-8121
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC128REOtherBLUE CROSS BLUE SHIELD
NC89128REMedicaid
NC128REOtherBLUE CROSS BLUE SHIELD
H34320Medicare UPIN