Healthcare Provider Details

I. General information

NPI: 1194934299
Provider Name (Legal Business Name): JOSHUA AARON MARKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WALNUT ST SUITE 500
PHILADELPHIA PA
19107-5563
US

IV. Provider business mailing address

1100 WALNUT ST STE 702
PHILADELPHIA PA
19107-5563
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6996
  • Fax: 215-955-6010
Mailing address:
  • Phone: 215-955-6996
  • Fax: 215-955-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD428722
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD428722
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: