Healthcare Provider Details

I. General information

NPI: 1194810911
Provider Name (Legal Business Name): MARK D. URBAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 05/27/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US CENTERS FOR DISEASE CONTROL 4024 STIRRUP CREEK DR
DURHAM NC
27703
US

IV. Provider business mailing address

US CENTERS FOR DISEASE CONTROL 4024 STIRRUP CREEK DR
DURHAM NC
27703
US

V. Phone/Fax

Practice location:
  • Phone: 919-541-0562
  • Fax:
Mailing address:
  • Phone: 919-541-0562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2472B0301X
TaxonomyBiomedical Engineering Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5410562
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: