Provider Demographics
NPI:1538112875
Name:SCROGGS, MARK W (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:SCROGGS
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 1:55 VILCOM CENTER DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1689
Mailing Address - Country:US
Mailing Address - Phone:919-967-4836
Mailing Address - Fax:919-967-6498
Practice Address - Street 1:55 VILCOM CENTER DR
Practice Address - Street 2:SUITE 140
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1689
Practice Address - Country:US
Practice Address - Phone:919-967-4836
Practice Address - Fax:919-967-6498
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29400174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890839XMedicaid
NC890839XMedicaid
NC2102711MMedicare ID - Type UnspecifiedMEDICARE