Provider Demographics
NPI:1922256130
Name:MARKO, BRUCE HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:HOWARD
Last Name:MARKO
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 1:15830 JOHN J DELANEY DR
Mailing Address - Street 2:STE 250
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3294
Mailing Address - Country:US
Mailing Address - Phone:704-295-9099
Mailing Address - Fax:704-295-4299
Practice Address - Street 1:15830 JOHN J DELANEY DR
Practice Address - Street 2:STE 250
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277
Practice Address - Country:US
Practice Address - Phone:704-295-9099
Practice Address - Fax:704-295-4299
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601783174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist