Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 33087 | NC |
Y | 208600000X | Surgeon | 33087 | NC |
N | 2082S0105X | Plastic Hand Surgeon | 33087 | NC |
NPI | 1851376891 |
---|---|
Provider Name | Malcolm Wernick Marks |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 15/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200816000 | (05) | WV |
2733 | PARTNERS (01) | NC |
38713 | MEDCOST (01) | NC |
53965 | BCBS (01) | NC |
5671002 | AETNA (01) | |
6920080 | (05) | VA |
8953965 | (05) | NC |
B89667 | (02) | |
Q33087 | (05) | SC |