Healthcare Provider Details

I. General information

NPI: 1598862732
Provider Name (Legal Business Name): SALISBURY PEDIATRIC ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 WOODSON ST
SALISBURY NC
28144-3255
US

IV. Provider business mailing address

129 WOODSON ST
SALISBURY NC
28144-3255
US

V. Phone/Fax

Practice location:
  • Phone: 704-636-5576
  • Fax: 704-636-1755
Mailing address:
  • Phone: 704-636-5576
  • Fax: 704-636-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number39389
License Number StateNC

VIII. Authorized Official

Name: DR. MARK DAVID LINS
Title or Position: PRESIDENT
Credential: MD
Phone: 704-636-5576