Provider Demographics
NPI:1447293980
Name:CRISSMAN, MARK ANDERS (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDERS
Last Name:CRISSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 SHELBURNE CT
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-4730
Mailing Address - Country:US
Mailing Address - Phone:336-226-2448
Mailing Address - Fax:336-226-5894
Practice Address - Street 1:214 E ELM ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-3022
Practice Address - Country:US
Practice Address - Phone:336-226-2448
Practice Address - Fax:336-226-5894
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8925753Medicaid
NC202729EMedicare ID - Type Unspecified
NCC81447Medicare UPIN