Moore, Mark Benton

Moore, Mark Benton is an individual health care provider with primary practice located at 1000 Blythe Blvd , Charlotte NC 28203-5812. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Pediatrics is his primary health care specialty. Moore, Mark Benton can be contacted via phone (704) 355-4772.

Contact Information

Primary practice address
1000 Blythe Blvd Charlotte NC 28203-5812
Phone: (704) 355-4772
Fax: (704) 355-6227
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 9700154 North Carolina
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 18527 Tennessee
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X ARNP 9219935 Florida

Profile Details

NPI number 1205948981
LBN Legal business name Moore, Mark Benton
Credentials ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 31st, 2006
Last updated Dec 6th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205948981 NPPES
South Carolina MEDICAID NP1153
South Carolina MEDICAID 7005122

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