Healthcare Provider Details

I. General information

NPI: 1780681841
Provider Name (Legal Business Name): MARK M PASQUARETTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

IV. Provider business mailing address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-0161
  • Fax: 910-772-9202
Mailing address:
  • Phone: 910-343-0161
  • Fax: 910-772-9202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number9400968
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: