Provider Demographics
NPI:1437229168
Name:MARKS, FREDERICK GRAHAM (MAC)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:GRAHAM
Last Name:MARKS
Suffix:
Gender:M
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 W UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:ALFRED
Mailing Address - State:NY
Mailing Address - Zip Code:14802-1115
Mailing Address - Country:US
Mailing Address - Phone:607-587-9401
Mailing Address - Fax:
Practice Address - Street 1:29 W UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:ALFRED
Practice Address - State:NY
Practice Address - Zip Code:14802-1115
Practice Address - Country:US
Practice Address - Phone:607-587-9401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000636-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist