Provider Demographics
NPI:1508827825
Name:ABRAMS, MARK JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JEFFREY
Last Name:ABRAMS
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 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:
Practice Address - Street 1:200 S HERLONG AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3399
Practice Address - Country:US
Practice Address - Phone:803-328-1864
Practice Address - Fax:803-328-1865
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001456207Y00000X
SCMD 19159207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC191599Medicaid
NC738506OtherCOVENTRY
SC01146093OtherAMERIGROUP COMMUNITY CARE
SC20040529OtherSELECT HEALTH OF SC/FIRST CHOICE
3150341OtherAETNA
C5520OtherMEDCOST
NC152HJOtherBCBSNC
SC85378OtherCHC CARES OF SC
3108752OtherMAMSI
SC773586OtherWELLCARE
P00059548OtherMEDICARE RR
SCGA79095874Medicare PIN
C5520OtherMEDCOST
NC2034294Medicare PIN