Healthcare Provider Details

I. General information

NPI: 1720173420
Provider Name (Legal Business Name): PHILLIP GLENN MARKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 LAKE BOONE TRL STE 203
RALEIGH NC
27607-7505
US

IV. Provider business mailing address

5221 PARAMOUNT PKWY STE 220
MORRISVILLE NC
27560-5490
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-2930
  • Fax: 919-784-2929
Mailing address:
  • Phone: 984-215-4111
  • Fax: 910-362-9123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number39444
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: