Provider Demographics
NPI:1427005693
Name:PRINCELL, MARK H (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:PRINCELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-2168
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:2755 SOUTH HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4902
Practice Address - Country:US
Practice Address - Phone:864-879-1948
Practice Address - Fax:864-560-4413
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC012832207P00000X
SC12832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC215514OtherMEDCOST
SC128329Medicaid
SC7004322OtherAETNA
SC128329Medicaid
SC215514OtherMEDCOST
SCB92392Medicare UPIN
SCB92392Medicare PIN