Provider Demographics
NPI:1366434557
Name:KINTER, MARK EDWARD (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:KINTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6750 CAROLINA BLVD
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-7052
Mailing Address - Country:US
Mailing Address - Phone:828-627-2211
Mailing Address - Fax:828-627-2216
Practice Address - Street 1:30 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NC
Practice Address - Zip Code:28716-3805
Practice Address - Country:US
Practice Address - Phone:828-646-0080
Practice Address - Fax:828-627-2216
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9900274207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891236YMedicaid
NCF88366Medicare UPIN
NC2279806Medicare ID - Type Unspecified