Provider Demographics
NPI:1629068283
Name:MALTON, MARK LELAND (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:LELAND
Last Name:MALTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 60160
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0160
Mailing Address - Country:US
Mailing Address - Phone:704-365-0555
Mailing Address - Fax:704-367-8122
Practice Address - Street 1:135 S SHARON AMITY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2842
Practice Address - Country:US
Practice Address - Phone:704-365-0555
Practice Address - Fax:704-367-8122
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2023-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC31869207WX0109X, 207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC208460EMedicare PIN
NCC85292Medicare UPIN