Healthcare Provider Details

I. General information

NPI: 1760458558
Provider Name (Legal Business Name): MARSHALL B. FRINK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N. MAIN STREET
KENANSVILLE NC
28349
US

IV. Provider business mailing address

PO BOX 651062
CHARLOTTE NC
28265-1062
US

V. Phone/Fax

Practice location:
  • Phone: 910-296-0941
  • Fax: 910-296-2034
Mailing address:
  • Phone: 800-377-8721
  • Fax: 304-523-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number26660
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: