Provider Demographics
NPI:1467612838
Name:MARKS, ELIZABETH R (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:R
Last Name:MARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:R
Other - Last Name:CAVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1444 WESTERN AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3458
Mailing Address - Country:US
Mailing Address - Phone:518-452-0587
Mailing Address - Fax:518-218-0152
Practice Address - Street 1:1444 WESTERN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3458
Practice Address - Country:US
Practice Address - Phone:518-452-0587
Practice Address - Fax:518-218-0152
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257434208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03246953Medicaid
NY03246953Medicaid