Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 33818 | NC |
NPI | 1154320307 |
---|---|
Provider Name | Dr. John Mark Englehardt |
First Address | Raleigh, NC 27604-0010 |
Second Address | Raleigh, NC 27610-1231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 23/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8930652 | (05) | NC |
E77242 | (02) | NC |