Provider Demographics
NPI:1689613796
Name:JABEN, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:JABEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 BOARDWALK LN
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-6863
Mailing Address - Country:US
Mailing Address - Phone:828-456-4159
Mailing Address - Fax:
Practice Address - Street 1:78 BOARDWALK LN
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-6863
Practice Address - Country:US
Practice Address - Phone:828-456-4159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29599207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132U5Medicaid
SCQ29591Medicaid
132U5OtherBCBS OF NC
P00010547OtherRAILROAD
132U5OtherBCBS OF NC
NC213217BMedicare PIN
NC213217DMedicare PIN