1467454033 NPI number — JEFFREY ALAN MARKS DPM

Table of content: ERICA MICHELLE MATHEWS (NPI 1912520206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467454033 NPI number — JEFFREY ALAN MARKS DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARKS
Provider First Name:
JEFFREY
Provider Middle Name:
ALAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1467454033
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
161 OLD SCHOOLHOUSE LN
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
MECHANICSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17055-5684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-697-7602
Provider Business Mailing Address Fax Number:
717-796-0921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 OLD SCHOOLHOUSE LN
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
MECHANICSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17055-5684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-697-7602
Provider Business Practice Location Address Fax Number:
717-796-0921
Provider Enumeration Date:
08/12/2005

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: 213ES0103X , with the licence number:  SC003128L , 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)

  • Identifier: 421607 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 814698 . This is a "US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 12495910001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 852306 . This is a "US HEALTHCARE CPPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 03066100 . This is a "CAPITAL BLUE CROSS GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1288963 . This is a "MEDICAID ACCESS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 678599 . This is a "FEDEARL BLUE SHIELD FEP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7990483 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 814698 . This is a "US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480012700 . This is a "METRAHEALTH RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 678599 . This is a "HIGHMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 678599 990483 . This is a "KEYSTONE AND SR BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01122901 . This is a "CAPITAL BLUE CROSS INDIVI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1288963 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480012700 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com