Individual
MARK PATRICK EZEKIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
298 COMMERCE DR, NEWBERRY, SC 29108-2953
(803) 321-3232
(803) 321-3234
Mailing address
298 COMMERCE DR, NEWBERRY, SC 29108-2953
(803) 321-3232
(803) 321-3234
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
21440
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21440
LICENSE
SC
05
—
214404
—
SC
01
—
8965
MEDICARE PTAN
SC
Enumeration date
03/17/2006
Last updated
04/04/2024
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