Provider Demographics
NPI:1952388266
Name:AMALFITANO, MARK ALBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALBERT
Last Name:AMALFITANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:911 W HENDERSON ST STE 300
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2700
Practice Address - Country:US
Practice Address - Phone:704-636-9270
Practice Address - Fax:704-210-0302
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-03781207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001655641Medicaid
PA628731Medicare ID - Type Unspecified
PA0016556410002Medicaid