Provider Demographics
NPI:1508820432
Name:DUFINE, MARK JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JEFFREY
Last Name:DUFINE
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 1:4402 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6161
Mailing Address - Country:US
Mailing Address - Phone:910-202-3363
Mailing Address - Fax:910-791-9626
Practice Address - Street 1:4402 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6161
Practice Address - Country:US
Practice Address - Phone:910-202-3363
Practice Address - Fax:910-791-9626
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38933207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC235110Medicaid
NC8929274Medicaid
NC29274OtherBCBS
NC29274OtherBCBS
NC2152655RMedicare PIN
NC235110Medicare ID - Type Unspecified