Provider Demographics
NPI:1275535072
Name:MORGAN, MARK WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WAYNE
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1404 COMMONWEALTH DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1473
Mailing Address - Country:US
Mailing Address - Phone:910-343-0119
Mailing Address - Fax:910-343-8983
Practice Address - Street 1:2305 CANTERWOOD DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7300
Practice Address - Country:US
Practice Address - Phone:910-343-0119
Practice Address - Fax:910-343-8983
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2004005582086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCI16093Medicare UPIN