Provider Demographics
NPI:1710421615
Name:JEFFREY A. MARKS, DPM PC
Entity Type:Organization
Organization Name:JEFFREY A. MARKS, DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-697-7602
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 STE 2
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-5680
Practice Address - Country:US
Practice Address - Phone:717-697-7602
Practice Address - Fax:717-796-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003128L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty