Individual
MARYANNA C TER POORTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
335 PENNY LN, CONCORD, NC 28025-1221
(704) 784-5901
(704) 721-0413
Mailing address
335 PENNY LN, CONCORD, NC 28025-1221
(704) 784-5901
(704) 721-0413
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
2003-00893
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89134VK
—
NC
01
—
P00232695
MEDICARE RAILROAD
NC
Enumeration date
12/19/2005
Last updated
02/12/2009
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