Provider Demographics
NPI:1013097963
Name:PAYNE, MARK ALAN (PA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:PAYNE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 WESTWOOD AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4315
Mailing Address - Country:US
Mailing Address - Phone:336-884-1800
Mailing Address - Fax:
Practice Address - Street 1:404 WESTWOOD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4315
Practice Address - Country:US
Practice Address - Phone:336-884-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100907207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
2749147EMedicare PIN
R39707Medicare UPIN