Provider Demographics
NPI:1801952494
Name:FIELDS, MARK LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEWIS
Last Name:FIELDS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1203 GORRELL ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-3421
Mailing Address - Country:US
Mailing Address - Phone:336-333-3953
Mailing Address - Fax:336-419-4484
Practice Address - Street 1:1203 GORRELL ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-3421
Practice Address - Country:US
Practice Address - Phone:336-333-3953
Practice Address - Fax:336-419-4484
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2014-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC28970207Q00000X
GA26775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC83757Medicare UPIN