Moore, Mark Benton
Moore, Mark Benton is an individual health care provider with primary practice located at 1000 Blythe Blvd , Charlotte NC 28203-5812. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Pediatrics is his primary health care specialty. Moore, Mark Benton can be contacted via phone (704) 355-4772.Contact Information
Primary practice address
1000 Blythe Blvd
Charlotte NC 28203-5812
Phone: (704) 355-4772
Fax: (704) 355-6227
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics | 363LP0200X | 9700154 | North Carolina |
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | 18527 | Tennessee |
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics | 363LP0200X | ARNP 9219935 | Florida |
Profile Details
NPI number | 1205948981 |
---|---|
LBN Legal business name | Moore, Mark Benton |
Credentials | ARNP |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Aug 31st, 2006 |
Last updated | Dec 6th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1205948981 | NPPES |
South Carolina | MEDICAID | NP1153 | |
South Carolina | MEDICAID | 7005122 |
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