Healthcare Provider Details

I. General information

NPI: 1447796933
Provider Name (Legal Business Name): MARK LAW PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/09/2017
Certification Date:
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: 704-216-2011
Mailing address:
  • Phone: 704-636-5576
  • Fax: 704-216-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-06951
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: