Provider Demographics
NPI:1558596965
Name:MARKS, TOLIETH CANDICE (INTERN)
Entity Type:Individual
Prefix:MRS
First Name:TOLIETH
Middle Name:CANDICE
Last Name:MARKS
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CIRCUIT ST
Mailing Address - Street 2:2
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1925
Mailing Address - Country:US
Mailing Address - Phone:617-708-0686
Mailing Address - Fax:617-708-0686
Practice Address - Street 1:55 DIMOCK ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1029
Practice Address - Country:US
Practice Address - Phone:617-442-8800
Practice Address - Fax:617-442-6268
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program