Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 13228 | SC |
Y | 207V00000X | Obstetrician & Gynecologist | 2009-00338 | NC |
NPI | 1023055977 |
---|---|
Provider Name | Mark S Dermer |
First Address | Concord, NC 28025-2927 |
Second Address | Concord, NC 28025-2927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 13/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
132289 | (05) | SC |
232009 | MEDICARE GROUP PTAN (01) | NC |
5911607 | (05) | NC |
A01901 | (02) |