Provider Demographics
NPI:1760501407
Name:CUNDIFF, MARK CURTIS (CFA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CURTIS
Last Name:CUNDIFF
Suffix:
Gender:M
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CHANTILLY RUE CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-5365
Mailing Address - Country:US
Mailing Address - Phone:828-691-1338
Mailing Address - Fax:864-688-2020
Practice Address - Street 1:11 CHANTILLY RUE CT
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-5365
Practice Address - Country:US
Practice Address - Phone:828-691-1338
Practice Address - Fax:864-688-2020
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102321246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist