Provider Demographics
NPI:1629028840
Name:MCDOWELL INTERNAL MEDICINE, PA
Entity Type:Organization
Organization Name:MCDOWELL INTERNAL MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:828-652-7776
Mailing Address - Street 1:100 SPAULDING RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-5172
Mailing Address - Country:US
Mailing Address - Phone:828-652-7776
Mailing Address - Fax:828-652-7801
Practice Address - Street 1:100 SPAULDING RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-5172
Practice Address - Country:US
Practice Address - Phone:828-652-7776
Practice Address - Fax:828-652-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60364207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCN4218OtherRAILROAD MEDICARE
NC890215GMedicaid
NC890215GMedicaid