Provider Demographics
NPI:1447300173
Name:BARTZ, MARK ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:BARTZ
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 1:1506 SPRING STREET
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4071
Mailing Address - Country:US
Mailing Address - Phone:864-227-3117
Mailing Address - Fax:864-227-1924
Practice Address - Street 1:1506 SPRING STREET
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4071
Practice Address - Country:US
Practice Address - Phone:864-227-3117
Practice Address - Fax:864-227-1924
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC6837Medicaid
SC12924OtherSTATE LICENSE
SCPC6837Medicaid
SCD057173082Medicare PIN