Healthcare Provider Details

I. General information

NPI: 1710131529
Provider Name (Legal Business Name): MARK HARRIS KOLENDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5244B N SHARON AMITY RD
CHARLOTTE NC
28215-0053
US

IV. Provider business mailing address

5617 RAMSEY STREET ATTN: REBECCA WRIGHT
FAYETTEVILLE NC
28311-1423
US

V. Phone/Fax

Practice location:
  • Phone: 704-536-0073
  • Fax: 704-535-5722
Mailing address:
  • Phone: 910-483-7337
  • Fax: 910-483-0648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number10914
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2017-01979
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: