1205087954 NPI number — DR. KATHERINE CHILEK MARKS D.O.

Table of content: DR. KATHERINE CHILEK MARKS D.O. (NPI 1205087954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205087954 NPI number — DR. KATHERINE CHILEK MARKS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARKS
Provider First Name:
KATHERINE
Provider Middle Name:
CHILEK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHILEK
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
DOUGLASS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205087954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 WOODBINE LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-271-8050
Provider Business Mailing Address Fax Number:
570-271-5940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 WOODBINE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17821-9118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-271-8050
Provider Business Practice Location Address Fax Number:
570-271-5940
Provider Enumeration Date:
09/30/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  OS015302 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207NP0225X , with the licence number: OS015302 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)