Provider Demographics
NPI:1851396998
Name:MARKS, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:MARKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 EXPOSITION PL
Mailing Address - Street 2:SUITE 161
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1563
Mailing Address - Country:US
Mailing Address - Phone:919-841-0848
Mailing Address - Fax:919-841-0239
Practice Address - Street 1:700 EXPOSITION PL
Practice Address - Street 2:SUITE 161
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-1563
Practice Address - Country:US
Practice Address - Phone:919-841-0848
Practice Address - Fax:919-841-0239
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28825174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC203733Medicare PIN
NCC82044Medicare UPIN