Provider Demographics
NPI:1891782504
Name:NESKY, MARK ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:NESKY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2240 REMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4725
Mailing Address - Country:US
Mailing Address - Phone:704-671-5311
Mailing Address - Fax:704-671-5308
Practice Address - Street 1:2711 X RAY DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7491
Practice Address - Country:US
Practice Address - Phone:704-834-2465
Practice Address - Fax:704-834-2466
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2007-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9701515207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN01516Medicaid
NC89126UHMedicaid
NC89126UHMedicaid
SCN01516Medicaid