Active NPI
Mark Andrew Medlin, D.M.D.
- General Practice Dentistry
- Lexington, SC
National Provider Identifier
1609803014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3939
- Practice address
- 135 Charter Oak Rd
Lexington, SC 29072-9246 - Phone
- (803) 785-4040
- Fax
- (803) 785-6275
- NPI assigned
- Jun 28, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3939 | SC | Primary |
Addresses
Primary practice location
135 Charter Oak Rd
Lexington, SC 29072-9246
Mailing address
PO Box 2378
Lexington, SC 29071-2378
Phone (803) 785-4040
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3939 | Other | SC | STATE LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3939 | SC | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609803014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2378",
"city": "LEXINGTON",
"state": "SC",
"postal_code": "290712378",
"telephone_number": "803-785-4040",
"fax_number": "803-785-6275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "135 CHARTER OAK RD",
"city": "LEXINGTON",
"state": "SC",
"postal_code": "290729246",
"telephone_number": "803-785-4040",
"fax_number": "803-785-6275"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDLIN",
"first_name": "MARK",
"middle_name": "ANDREW",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "3939",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "3939",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lexington, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.