Provider Demographics
NPI:1053391557
Name:ISSERMAN, MARK S (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:ISSERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 602381
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2381
Mailing Address - Country:US
Mailing Address - Phone:828-883-2131
Mailing Address - Fax:828-883-4550
Practice Address - Street 1:89 MEDICAL PARK DR
Practice Address - Street 2:SUITE C
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3035
Practice Address - Country:US
Practice Address - Phone:828-883-2131
Practice Address - Fax:828-883-4550
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9500955207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8945485Medicaid
NCC57361Medicare UPIN
NC45485Medicare ID - Type Unspecified