Provider Demographics
NPI:1013064849
Name:PETERS, MARK S (PA-C)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:PETERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2679
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28802-2679
Mailing Address - Country:US
Mailing Address - Phone:828-213-0594
Mailing Address - Fax:828-213-0590
Practice Address - Street 1:534 BILTMORE AVENUE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4612
Practice Address - Country:US
Practice Address - Phone:828-213-0594
Practice Address - Fax:828-213-0590
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2012-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC102005363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2743529BMedicare PIN
NCS39978Medicare UPIN
NC2743529AMedicare PIN