Individual
MARK RICHARD IPPOLITO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 HAWTHORNE LN, CHARLOTTE, NC 28204-2515
(704) 384-9437
(704) 384-9440
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
(704) 384-7830
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
2000-00076
NC
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
2000-00076
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8912769
—
NC
Enumeration date
04/13/2006
Last updated
10/25/2020
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