Provider Demographics
NPI:1205836145
Name:MCCALL, MARK JEFFREY (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:JEFFREY
Last Name:MCCALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:312 MIDLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8102
Mailing Address - Country:US
Mailing Address - Phone:843-875-6262
Mailing Address - Fax:843-873-7958
Practice Address - Street 1:312 MIDLAND PKWY
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8102
Practice Address - Country:US
Practice Address - Phone:843-875-6262
Practice Address - Fax:843-873-7958
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC11124208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC111248Medicaid
SC20-11124OtherDHEC
SC11124OtherBOARD OF EXAMINERS
SC11124OtherBOARD OF EXAMINERS
SC111248Medicaid