Provider Demographics
NPI:1710131529
Name:KOLENDER, MARK HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HARRIS
Last Name:KOLENDER
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 1:5617 RAMSEY STREET
Mailing Address - Street 2:ATTN: REBECCA WRIGHT
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-1423
Mailing Address - Country:US
Mailing Address - Phone:910-483-7337
Mailing Address - Fax:910-483-0648
Practice Address - Street 1:5244B N SHARON AMITY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-0053
Practice Address - Country:US
Practice Address - Phone:704-536-0073
Practice Address - Fax:704-535-5722
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC109142083X0100X
NC2017-01979208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1212353OtherDHEA