Stallworth, Mark Jung
Stallworth, Mark Jung is an individual health care provider with primary practice located at 1900 S Hawthorne Rd , Winston Salem NC 27103-3913. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Stallworth, Mark Jung can be contacted via phone (336) 970-5300.Contact Information
Primary practice address
1900 S Hawthorne Rd
Winston Salem NC 27103-3913
Phone: (336) 970-5300
Fax: (336) 659-2379
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 9401055 | North Carolina |
| Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology | 2085R0204X | 9401055 | North Carolina |
Profile Details
| NPI number | 1912958794 |
|---|---|
| LBN Legal business name | Stallworth, Mark Jung |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 15th, 2006 |
| Last updated | Sep 14th, 2016 - about 8 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 | 1912958794 | NPPES |
| North Carolina | MEDICAID | 8979159 |
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