1346280245 NPI number — MR. THOMAS MARX DO MD

Table of content: MR. THOMAS MARX DO MD (NPI 1346280245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346280245 NPI number — MR. THOMAS MARX DO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DO
Provider First Name:
THOMAS
Provider Middle Name:
MARX
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1346280245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 DATA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CORDOVA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95670-7956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-861-1486
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8120 TIMBERLAKE WAY STE 107
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95823-5413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-681-6000
Provider Business Practice Location Address Fax Number:
916-681-6188
Provider Enumeration Date:
06/08/2006

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: 207R00000X , with the licence number:  0101238253 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: A78702 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 184440 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 254185 . This is a "KAISER PERMANENTE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 496675 . This is a "MDIPA OPTIMUM CHOICE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: A78702 . This is a "MEDICAL STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 010222338 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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