Provider Demographics
NPI:1386764173
Name:FARUQUE, MARK A (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:FARUQUE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7008
Mailing Address - Country:US
Mailing Address - Phone:336-802-2536
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:174 BOLICK LN
Practice Address - Street 2:SUITE 202
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-3319
Practice Address - Country:US
Practice Address - Phone:828-495-8226
Practice Address - Fax:828-495-4191
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2013-06-07
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Provider Licenses
StateLicense IDTaxonomies
NC33651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8931374Medicaid
NC348918AMedicaid
NC349819Medicare ID - Type Unspecified
NC348918AMedicaid
NCNCB829AMedicare PIN