Basic Information
| Provider Information | |||||||||
| NPI: | 1285194662 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HYLARIDES | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | JUSTIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | MEDICAL CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271570001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366518100 | ||||||||
| FaxNumber: | 3367160030 | ||||||||
| Practice Location | |||||||||
| Address1: | 1370 W D ST | ||||||||
| Address2: | |||||||||
| City: | NORTH WILKESBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286593506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366518100 | ||||||||
| FaxNumber: | 3367160030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2019 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD61200401 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 2022-02050 | NC | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.