Provider Demographics
NPI:1952348682
Name:LANDERS, MARK D (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:LANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 REGIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9796
Mailing Address - Country:US
Mailing Address - Phone:910-715-8600
Mailing Address - Fax:910-715-8613
Practice Address - Street 1:7 REGIONAL CIR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9796
Practice Address - Country:US
Practice Address - Phone:910-715-8600
Practice Address - Fax:910-715-8613
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300170207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFH2001400OtherFIRST CAROLINA CARE
NC89133N5Medicaid
NCA009OtherHEALTHNET
NC133N5OtherBLUE CROSS/BLUE SHIELD
NC9878835OtherCIGNA
SCN00176OtherSC MEDICAID
NCP00039438OtherRAILROAD
NC9878835OtherCIGNA
NC89133N5Medicaid