Provider Demographics
NPI:1679898548
Name:MARKY, ANDREW HALL
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:HALL
Last Name:MARKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7825 BALLANTYNE COMMONS PKWY STE 150
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3175
Practice Address - Country:US
Practice Address - Phone:704-316-3070
Practice Address - Fax:704-316-3071
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6652207T00000X
NC2019-00191207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX362033801Medicaid
TX8GA358OtherBCBS
TX8GA344OtherBCBS
TX8GA344OtherBCBS
TX518208ZSVEMedicare PIN