Provider Demographics
NPI:1265442461
Name:MARKS, NEAL ALAN (DPM)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:ALAN
Last Name:MARKS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21360 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116
Mailing Address - Country:US
Mailing Address - Phone:440-333-5888
Mailing Address - Fax:440-333-6766
Practice Address - Street 1:21360 CENTER RIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116
Practice Address - Country:US
Practice Address - Phone:440-333-5888
Practice Address - Fax:440-333-6766
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002500213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0706776Medicaid
T80591Medicare UPIN
OH0706776Medicaid
OH0841761Medicare PIN