MEDICARE: MARC KENNETH DY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	9601293	NC
2	207Q00000X	Family Medicine Physician	9601293	NC

General Provider Information

NPI Number	:	1366412207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC KENNETH DY MD

Provider Business Mailing Address
First Line	:	PO BOX 19305
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28219-9305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10030 EDISON SQUARE DR NW
Second Line	:	STE 100
City	:	CONCORD
State	:	NC
Zip	:	28027-8308
Country	:	US
Telephone Number	:	704-403-7830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	09/25/2025

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Directions to “ MARC KENNETH DY MD” Practice Location

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