1063447613 NPI number — DR. MELISSA MARKS M.D.

Table of content: DR. MELISSA MARKS M.D. (NPI 1063447613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063447613 NPI number — DR. MELISSA MARKS M.D.

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063447613
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 WASHINGTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08544-2002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-258-3141
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 WASHINGTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08544-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-258-3141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2006

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: 208000000X , with the licence number:  D59148 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 25MA10992800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: D59148 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 511707100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: S1390036 . This is a "GBMC CAREFIRST REGIONAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5453449 . This is a "AETNA NON HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1202288 . This is a "UHC AMERICHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 215973 . This is a "KAISER PERM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2120475 . This is a "MAMSI GBMC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 13797 . This is a "HOPKINS GBMC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2121615 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: KJ50-61689802 . This is a "GBMC CAREFIRST MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 113065 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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