Organization
CAROLINAS EAR NOSE & THROAT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ANTHONY LIZAK MD (PHYSICIAN)
(910) 754-2920
Entity
Organization
Contact information
Practice address
14 MEDICAL CENTER DRIVE, SUPPLY, NC 28462-3350
(910) 754-2920
(910) 754-2268
Mailing address
14 MEDICAL CENTER DRIVE, SUPPLY, NC 28462-3350
(910) 754-2920
(910) 754-2268
Taxonomy
Speciality
Code
Description
License number
State
207YX0901X
Otology & Neurotology Physician
Primary
35160
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0295N
BCBS NC
NC
05
—
8952324
—
NC
Enumeration date
08/02/2006
Last updated
07/24/2010
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