Healthcare Provider Details

I. General information

NPI: 1467612838
Provider Name (Legal Business Name): ELIZABETH R MARKS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH R CAVO M.D.

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 WESTERN AVE SUITE D
ALBANY NY
12203-3458
US

IV. Provider business mailing address

1444 WESTERN AVE SUITE D
ALBANY NY
12203-3458
US

V. Phone/Fax

Practice location:
  • Phone: 518-452-0587
  • Fax: 518-218-0152
Mailing address:
  • Phone: 518-452-0587
  • Fax: 518-218-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number257434
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number257434
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: