Provider Demographics
NPI:1497996805
Name:HEPLER, MARK ELLIS (PA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ELLIS
Last Name:HEPLER
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:3625 N ELM ST STE 110A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2697
Mailing Address - Country:US
Mailing Address - Phone:336-398-5656
Mailing Address - Fax:336-398-5665
Practice Address - Street 1:3625 N ELM ST STE 110A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455
Practice Address - Country:US
Practice Address - Phone:336-398-5656
Practice Address - Fax:336-398-5665
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2018-07-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-01736363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2762010BMedicare PIN