Provider Demographics
NPI:1932536927
Name:MARKS, MELVIN I (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:I
Last Name:MARKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:258 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-1522
Mailing Address - Country:US
Mailing Address - Phone:714-402-3027
Mailing Address - Fax:562-933-9707
Practice Address - Street 1:1501 SUPERIOR AVE
Practice Address - Street 2:SUITE #111 & 311
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3600
Practice Address - Country:US
Practice Address - Phone:949-631-3454
Practice Address - Fax:949-631-2787
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG59098208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice