Healthcare Provider Details

I. General information

NPI: 1821041880
Provider Name (Legal Business Name): PAUL MARK KOCSIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 US 421 S
LILLINGTON NC
27546-6713
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR STE 100
CONCORD NC
28025-1833
US

V. Phone/Fax

Practice location:
  • Phone: 910-893-5727
  • Fax: 910-893-6404
Mailing address:
  • Phone: 704-939-1100
  • Fax: 704-939-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9400881
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: