Provider Demographics
NPI:1588615819
Name:VISK, MARK D (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:D
Last Name:VISK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:303 E WOOD STREET
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3020
Mailing Address - Country:US
Mailing Address - Phone:864-208-8800
Mailing Address - Fax:864-208-0318
Practice Address - Street 1:303 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3020
Practice Address - Country:US
Practice Address - Phone:864-208-8800
Practice Address - Fax:864-208-0318
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12801207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC128016Medicaid
SC128016Medicaid
SCA020258499Medicare PIN