Provider Demographics
NPI:1417931213
Name:LE, MARK TUAN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:TUAN
Last Name:LE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:17705 SPRING WINDS DR
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-7744
Mailing Address - Country:US
Mailing Address - Phone:704-896-3313
Mailing Address - Fax:704-896-8193
Practice Address - Street 1:16511 NORTHCROSS DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5021
Practice Address - Country:US
Practice Address - Phone:704-896-3313
Practice Address - Fax:704-896-8193
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9700088207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891067YMedicaid
NC891067YMedicaid
NC2242460FMedicare ID - Type Unspecified