Provider Demographics
NPI:1336308287
Name:MARKS, JARED JOSEPH
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:JOSEPH
Last Name:MARKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9910 FRANKLIN SQUARE DR STE 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:
Practice Address - Street 1:6420 ROCKLEDGE DR STE 4920
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-7848
Practice Address - Country:US
Practice Address - Phone:301-896-6069
Practice Address - Fax:301-896-8802
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST1861207T00000X
MDD77498207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2359932Medicaid
MS06682557Medicaid
LA2359932Medicaid
MS302I144632Medicare PIN
MSP01037077Medicare PIN