Provider Demographics
NPI:1699848499
Name:FOX, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:FOX
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 1:4604 BLITSGEL DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-9015
Mailing Address - Country:US
Mailing Address - Phone:843-453-3964
Mailing Address - Fax:843-418-9284
Practice Address - Street 1:2115 W JODY RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-2031
Practice Address - Country:US
Practice Address - Phone:843-453-3963
Practice Address - Fax:843-418-9284
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14344207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC143446Medicaid
SC143446Medicaid
SCE137148552Medicare ID - Type Unspecified