Healthcare Provider Details

I. General information

NPI: 1477751717
Provider Name (Legal Business Name): ALICIA GRACE MARKS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA GRACE BALOGH DO

II. Dates (important events)

Enumeration Date: 07/09/2007
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 5640
ALBUQUERQUE NM
87106-4920
US

IV. Provider business mailing address

PO BOX 26666
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-6530
  • Fax: 505-563-6325
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberDO2024-0145
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: