Provider Demographics
NPI:1144208158
Name:DARST, MARC ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ALAN
Last Name:DARST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5304
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-5304
Mailing Address - Country:US
Mailing Address - Phone:704-321-3376
Mailing Address - Fax:704-541-6558
Practice Address - Street 1:11301 GOLF LINKS DR N
Practice Address - Street 2:SUITE 203
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8013
Practice Address - Country:US
Practice Address - Phone:704-321-3376
Practice Address - Fax:704-541-6558
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081826D207N00000X
IN01039578207P00000X
OH35-081826207ND0900X
NC2008-00083207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F20453Medicare UPIN