Provider Demographics
NPI:1821150699
Name:MARKS, DAVID A (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:MARKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ROUTE 1 STE 26
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-4712
Mailing Address - Country:US
Mailing Address - Phone:207-846-3023
Mailing Address - Fax:207-846-3028
Practice Address - Street 1:500 ROUTE 1 STE 26
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-4712
Practice Address - Country:US
Practice Address - Phone:207-846-3023
Practice Address - Fax:207-846-3028
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS602103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEANTHEM BLUE CROSSOther003257