Provider Demographics
NPI:1548210115
Name:CALL, MARK DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DOUGLAS
Last Name:CALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:STE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:890 W FARIS RD
Practice Address - Street 2:STE 520
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4253
Practice Address - Country:US
Practice Address - Phone:864-455-9033
Practice Address - Fax:864-455-6559
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC23069207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAPPROVEDMedicaid
SCAPPROVEDMedicaid
SC230690Medicaid
SCP00797710OtherRR MEDICARE
SCH692183640Medicare PIN
SCH692187951Medicare PIN
SC7931483OtherAETNA
SC57-6007863114OtherBLUE CHOICE OF SC
SCH69218Medicare UPIN