Provider Demographics
NPI:1700846672
Name:CERVI, MARK R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:CERVI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1900 BLOOMSBURY RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-9603
Mailing Address - Country:US
Mailing Address - Phone:252-917-4226
Mailing Address - Fax:252-689-4315
Practice Address - Street 1:1900 BLOOMSBURY RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-9603
Practice Address - Country:US
Practice Address - Phone:252-917-4226
Practice Address - Fax:252-689-4315
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC34271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2599238Medicare ID - Type Unspecified
NCP12897Medicare UPIN