Provider Demographics
NPI:1922048966
Name:SIMPSON, MARK W (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:SIMPSON
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 1:1001 CRESCENT GRN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8101
Mailing Address - Country:US
Mailing Address - Phone:919-467-3211
Mailing Address - Fax:919-235-3094
Practice Address - Street 1:1001 CRESCENT GRN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8101
Practice Address - Country:US
Practice Address - Phone:919-235-3042
Practice Address - Fax:919-235-3094
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25747208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8968740Medicaid
NC8976409Medicare ID - Type Unspecified
NC8968740Medicaid