Provider Demographics
NPI:1639194723
Name:BUCY, MARK C (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:BUCY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:520 S VAN BUREN RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5201
Mailing Address - Country:US
Mailing Address - Phone:336-627-5437
Mailing Address - Fax:336-627-1681
Practice Address - Street 1:520 S VAN BUREN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5201
Practice Address - Country:US
Practice Address - Phone:336-627-5437
Practice Address - Fax:336-627-1681
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200100650208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89130NUMedicaid
VA6733611Medicaid
H48105Medicare UPIN