Healthcare Provider Details

I. General information

NPI: 1437229168
Provider Name (Legal Business Name): FREDERICK GRAHAM MARKS M.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 W UNIVERSITY ST
ALFRED NY
14802-1115
US

IV. Provider business mailing address

29 W UNIVERSITY ST
ALFRED NY
14802-1115
US

V. Phone/Fax

Practice location:
  • Phone: 607-587-9401
  • Fax:
Mailing address:
  • Phone: 607-587-9401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000636-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: