Individual
MARK S DERMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
920 CHURCH ST N, NE OB/GYN HOSPITALIST SERVICES, CONCORD, NC 28025-2927
(704) 403-1632
(704) 403-1356
Mailing address
920 CHURCH ST N, NE OB/GYN HOSPITALIST SERVICES, CONCORD, NC 28025-2927
(704) 403-1632
(704) 403-1356
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
13228
SC
207V00000X
Obstetrics & Gynecology Physician
Primary
2009-00338
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132289
—
SC
01
—
232009
MEDICARE GROUP PTAN
NC
05
—
5911607
—
NC
Enumeration date
06/01/2006
Last updated
08/13/2009
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