Provider Demographics
NPI:1366443509
Name:EMERY, MARK THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:THOMAS
Last Name:EMERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-637-5668
Mailing Address - Fax:704-637-5605
Practice Address - Street 1:330 JAKE ALEXANDER BLVD W
Practice Address - Street 2:SUITE 101
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1384
Practice Address - Country:US
Practice Address - Phone:704-637-5668
Practice Address - Fax:704-637-5605
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC104310207Y00000X
NC200100352174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129KJMedicaid
NCG87081Medicare UPIN
NC2332550Medicare PIN