Provider Demographics
NPI:1588643597
Name:MICHAUD, MARK E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:MICHAUD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2511 OLD CORNWALLIS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1869
Mailing Address - Country:US
Mailing Address - Phone:919-932-5700
Mailing Address - Fax:919-933-6881
Practice Address - Street 1:530 NEW WAVERLY PL STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7414
Practice Address - Country:US
Practice Address - Phone:919-650-6066
Practice Address - Fax:919-882-1378
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2021-12-29
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Provider Licenses
StateLicense IDTaxonomies
VA0101256394207Q00000X
LAL023430207Q00000X
NC2017-00185207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN
VAVVE651AMedicare PIN
VA354216YWAUMedicare PIN