Healthcare Provider Details

I. General information

NPI: 1518883495
Provider Name (Legal Business Name): NATHANIEL MARKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NATHAN MARKS PA-C

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 LAFAYETTE RD
INDIANAPOLIS IN
46254-1102
US

IV. Provider business mailing address

5645 LAFAYETTE RD
INDIANAPOLIS IN
46254-1102
US

V. Phone/Fax

Practice location:
  • Phone: 317-387-3050
  • Fax:
Mailing address:
  • Phone: 317-387-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: