MEDICARE: MARK CHARLES NENOW 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	207Y00000X	Otolaryngology Physician	200500226	NC
2	207Y00000X	Otolaryngology Physician	29404	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P000261743	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942247085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK CHARLES NENOW MD

Provider Business Mailing Address
First Line	:	321 MULBERRY ST SW
Second Line	:	MEDICAL STAFF SERVICES
City	:	LENOIR
State	:	NC
Zip	:	28645-5720
Country	:	US
Telephone Number	:	828-757-5965
Fax Number	:	828-757-5104

Provider Business Practice Location Address
First Line	:	2010 GARFIELD AVE
Second Line	:
City	:	PARKERSBURG
State	:	WV
Zip	:	26101-2526
Country	:	US
Telephone Number	:	304-865-5535
Fax Number	:

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	04/18/2022

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Directions to “ MARK CHARLES NENOW MD” Practice Location

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