Healthcare Provider Details

I. General information

NPI: 1316009996
Provider Name (Legal Business Name): ERIC SPENCER MARKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GEORGIA AVE NW WRAMC, BLDG 2, DEPARTMENT OF MEDICINE
WASHINGTON DC
20307-0001
US

IV. Provider business mailing address

6900 GEORGIA AVE NW WRAMC, BLDG 2, ROOM 2J38
WASHINGTON DC
20307-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-9603
  • Fax: 301-295-3557
Mailing address:
  • Phone: 301-871-3758
  • Fax: 301-295-3557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberR6012
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: