Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | OS00999L | PA |
NPI | 1043232531 |
---|---|
Provider Name | Barry L Marks |
First Address | Philadelphia, PA 19144 |
Second Address | Philadelphia, PA 19144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 09/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0622421 | (05) | PA |
C27758 | (02) |