Provider Demographics
NPI:1912006628
Name:ELGART, MARK L (CPO)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:L
Last Name:ELGART
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 E 7TH ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3311
Mailing Address - Country:US
Mailing Address - Phone:704-334-1860
Mailing Address - Fax:704-347-2785
Practice Address - Street 1:2001 E 7TH ST
Practice Address - Street 2:SUITE I
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3311
Practice Address - Country:US
Practice Address - Phone:704-334-1860
Practice Address - Fax:704-347-2785
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14317OtherPARTNERS
NC7700566Medicaid
NC7795076Medicaid
NC7701450Medicaid
0141350005OtherMEDICARE PTAN