Provider Demographics
NPI:1750374161
Name:MARKS, BURTON (DO)
Entity type:Individual
Prefix:
First Name:BURTON
Middle Name:
Last Name:MARKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 PRINCE FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1846
Mailing Address - Country:US
Mailing Address - Phone:610-331-2326
Mailing Address - Fax:
Practice Address - Street 1:563 PRINCE FREDERICK ST
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1846
Practice Address - Country:US
Practice Address - Phone:610-331-2326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS001940L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007534140018Medicaid
PA0007534140018Medicaid
PAB96637Medicare UPIN