MEDICARE: MR. MARKEL LIMBACKER

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	1041C0700X	Clinical Social Worker	P017038	NC

General Provider Information

NPI Number	:	1710651443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARKEL LIMBACKER

Provider Business Mailing Address
First Line	:	1914 J N PEASE PL STE 130
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4504
Country	:	US
Telephone Number	:	704-626-0088
Fax Number	:

Provider Business Practice Location Address
First Line	:	12103 HUNTERS WHIP CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-8722
Country	:	US
Telephone Number	:	704-493-9980
Fax Number	:

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

Provider Enumeration Date	:	08/05/2021
Last Update Date	:	11/27/2023

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