Provider Demographics
NPI:1083751549
Name:MARKOW, MARY JANE (ND,MS,LAC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JANE
Last Name:MARKOW
Suffix:
Gender:F
Credentials:ND,MS,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 COURT STREET
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2211
Mailing Address - Country:US
Mailing Address - Phone:860-229-1490
Mailing Address - Fax:860-223-0468
Practice Address - Street 1:25 COURT ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2211
Practice Address - Country:US
Practice Address - Phone:860-229-1490
Practice Address - Fax:860-223-0468
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000200175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath