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Individual
MR. MARK ANTHONY PANE
Active
Individual
MR. MARK ANTHONY PANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
104208
NC
363AM0700X
Medical Physician Assistant
104208
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1064084
NC CERTIFICATION OF PA
NC
Enumeration date
05/08/2006
Last updated
05/23/2024
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