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Individual

MARK CAUTHEN WILLINGHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-7595
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-7595

Taxonomy

Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
9701197
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1069E
BCBS
05
2003688000
WV
01
220032284
RR MEDICARE
01
2279938A
MEDICARE
01
36474
PARTNERS
05
6605231
VA
01
7364331
AETNA
01
74320
MEDCOST
05
891069E
NC
05
Q01199
SC
Enumeration date
11/16/2005
Last updated
08/23/2010
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