Basic Information
| Provider Information | |||||||||
| NPI: | 1710959804 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARCHAND | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3949 BROWNING PL | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276096504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197877411 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3949 BROWNING PL | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276096504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197877411 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 07/01/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | 2007-00617 | NC | Y | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
ID Information
| ID | Type | State | Issuer | Description | 204246 | 01 | NC | MEDICARE | OTHER | 204315 | 01 | NC | MEDICARE | OTHER | 204326 | 01 | NC | MEDICARE | OTHER | 5908490 | 05 | NC | MEDICAID |