Provider Demographics
NPI:1285702597
Name:QUIST, MARK ALAN (DPM)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:QUIST
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16419 NORTHCROSS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5004
Mailing Address - Country:US
Mailing Address - Phone:704-987-9585
Mailing Address - Fax:704-987-9589
Practice Address - Street 1:16419 NORTHCROSS DR
Practice Address - Street 2:SUITE A
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5004
Practice Address - Country:US
Practice Address - Phone:704-987-9585
Practice Address - Fax:704-987-9589
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC424213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890801XMedicaid
NC2433439AMedicare ID - Type Unspecified
NC890801XMedicaid
NC4557050001Medicare NSC