Provider Demographics
NPI:1063447613
Name:MARKS, MELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:MARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08544-2002
Mailing Address - Country:US
Mailing Address - Phone:609-258-3141
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08544-2002
Practice Address - Country:US
Practice Address - Phone:609-258-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD59148208000000X, 208M00000X
NJ25MA10992800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD511707100Medicaid
MDS1390036OtherGBMC CAREFIRST REGIONAL
MD5453449OtherAETNA NON HMO
MD1202288OtherUHC AMERICHOICE
MD215973OtherKAISER PERM
MD2120475OtherMAMSI GBMC
MD13797OtherHOPKINS GBMC
MD2121615OtherAETNA HMO
MDKJ50-61689802OtherGBMC CAREFIRST MD
MD113065OtherAMERIGROUP