Provider Demographics
NPI:1467454033
Name:MARKS, JEFFREY ALAN (DPM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:MARKS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 OLD SCHOOLHOUSE LN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-5684
Mailing Address - Country:US
Mailing Address - Phone:717-697-7602
Mailing Address - Fax:717-796-0921
Practice Address - Street 1:161 OLD SCHOOLHOUSE LN
Practice Address - Street 2:SUITE 2
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-5684
Practice Address - Country:US
Practice Address - Phone:717-697-7602
Practice Address - Fax:717-796-0921
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003128L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
421607OtherAETNA US HEALTHCARE
PA814698OtherUS HEALTHCARE
12495910001OtherCIGNA
852306OtherUS HEALTHCARE CPPO
03066100OtherCAPITAL BLUE CROSS GROUP
1288963OtherMEDICAID ACCESS
678599OtherFEDEARL BLUE SHIELD FEP
PA7990483OtherGATEWAY
814698OtherUS HEALTHCARE
480012700OtherMETRAHEALTH RAILROAD
678599OtherHIGHMARK
678599 990483OtherKEYSTONE AND SR BLUE
01122901OtherCAPITAL BLUE CROSS INDIVI
PA1288963Medicaid
PA480012700OtherRAILROAD MEDICARE
480012700OtherMETRAHEALTH RAILROAD
678599OtherHIGHMARK
PA1288963Medicaid