Provider Demographics
NPI:1881762011
Name:PIFER, MARK A (DPM)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:PIFER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CRUTCHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2722
Mailing Address - Country:US
Mailing Address - Phone:919-477-5000
Mailing Address - Fax:919-477-0377
Practice Address - Street 1:114 CRUTCHFIELD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2722
Practice Address - Country:US
Practice Address - Phone:919-477-5000
Practice Address - Fax:919-477-0377
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC146213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908133Medicaid
NC7908132Medicaid
T64038Medicare UPIN
NC8908133Medicaid