Provider Demographics
NPI:1487604831
Name:BECK, MARK CRAIG (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:CRAIG
Last Name:BECK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11635 N MAIN ST
Mailing Address - Street 2:STE E
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263
Mailing Address - Country:US
Mailing Address - Phone:336-861-4110
Mailing Address - Fax:336-861-4295
Practice Address - Street 1:11635 N MAIN ST
Practice Address - Street 2:STE E
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263
Practice Address - Country:US
Practice Address - Phone:336-861-4110
Practice Address - Fax:336-861-4295
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC30119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8914271Medicaid
NC8914271Medicaid
NC203735Medicare ID - Type Unspecified