Provider Demographics
NPI:1013987908
Name:AUSTIN, MARK WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:WAYNE
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10510 JEFFERSON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-3102
Practice Address - Country:US
Practice Address - Phone:757-594-4720
Practice Address - Fax:757-594-4735
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2013-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101049499207V00000X
NC31705207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology