Healthcare Provider Details

I. General information

NPI: 1013924240
Provider Name (Legal Business Name): DOUGLAS F. MARKS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 MCGREGOR ST STE 4100
MANCHESTER NH
03102-3765
US

IV. Provider business mailing address

87 MCGREGOR ST STE 4100
MANCHESTER NH
03102-3765
US

V. Phone/Fax

Practice location:
  • Phone: 603-695-2500
  • Fax: 603-695-2647
Mailing address:
  • Phone: 603-695-2500
  • Fax: 603-695-2647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number12110
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: