Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | MD029223E | PA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | MD029223E | PA |
NPI | 1144281692 |
---|---|
Provider Name | Dr. Victor J Marks |
First Address | Danville, PA 17822-3034 |
Second Address | Danville, PA 17822-5206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 04/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000908160 | (05) | PA |
C29906 | (02) |