Provider Demographics
NPI:1851942593
Name:MARKS, MADISON LEIGH (CNIM)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:LEIGH
Last Name:MARKS
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 WATERVIEW PKWY STE 305
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1566
Mailing Address - Country:US
Mailing Address - Phone:214-551-0257
Mailing Address - Fax:
Practice Address - Street 1:3400 WATERVIEW PKWY STE 305
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-1566
Practice Address - Country:US
Practice Address - Phone:214-551-0257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4431246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic