Organization
BRUNSWICK SURGICAL ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK TILLOTSON M.D. (PARTNER)
(910) 575-4606
Entity
Organization
Contact information
Practice address
6 DOCTORS CIR, SUITE 1, SUPPLY, NC 28462-4089
(910) 575-4606
(910) 575-4609
Mailing address
6 DOCTORS CIR, SUITE 1, SUPPLY, NC 28462-4089
(910) 575-4606
(910) 575-4609
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
103114
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89015K7
—
NC
Enumeration date
12/15/2005
Last updated
08/22/2020
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