Healthcare Provider Details

I. General information

NPI: 1891782504
Provider Name (Legal Business Name): MARK ALLEN NESKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 X RAY DR
GASTONIA NC
28054-7491
US

IV. Provider business mailing address

2240 REMOUNT RD
GASTONIA NC
28054-4725
US

V. Phone/Fax

Practice location:
  • Phone: 704-834-2465
  • Fax: 704-834-2466
Mailing address:
  • Phone: 704-671-5311
  • Fax: 704-671-5308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number9701515
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: