Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 19369 | SC |
NPI | 1962470849 |
---|---|
Provider Name | Dr. Mark D Locke |
First Address | Belfast, ME 04915-4473 |
Second Address | Columbia, SC 29203-6877 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 09/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G46290 | (02) | SC |
T34246 | (05) | SC |