Provider Demographics
NPI:1184635518
Name:MARKS, CHARLES W (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:MARKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1464 MOUNT PLEASANT RD
Mailing Address - Street 2:SUITES 13 AND 14
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-4043
Mailing Address - Country:US
Mailing Address - Phone:757-410-4580
Mailing Address - Fax:757-410-4591
Practice Address - Street 1:1464 MOUNT PLEASANT RD
Practice Address - Street 2:SUITE 16 #502
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-4043
Practice Address - Country:US
Practice Address - Phone:757-410-4580
Practice Address - Fax:757-410-4591
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2010-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101035436207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5876150Medicaid
VAB07881Medicare UPIN
VAVAA101878Medicare PIN
VA00X6025C03Medicare PIN