Provider Demographics
NPI:1346317864
Name:MARSHALL, MARK ALLEN (PA)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALLEN
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:2165 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-8809
Mailing Address - Country:US
Mailing Address - Phone:828-294-9164
Mailing Address - Fax:828-330-2038
Practice Address - Street 1:2165 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-8809
Practice Address - Country:US
Practice Address - Phone:828-294-9164
Practice Address - Fax:828-330-2060
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2010-01-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC102463363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS73920Medicare UPIN
NC2749918Medicare ID - Type Unspecified