Healthcare Provider Details

I. General information

NPI: 1750374161
Provider Name (Legal Business Name): BURTON MARKS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 PRINCE FREDERICK ST
KING OF PRUSSIA PA
19406-1846
US

IV. Provider business mailing address

563 PRINCE FREDERICK ST
KING OF PRUSSIA PA
19406-1846
US

V. Phone/Fax

Practice location:
  • Phone: 610-331-2326
  • Fax:
Mailing address:
  • Phone: 610-331-2326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOS001940L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: