Healthcare Provider Details

I. General information

NPI: 1225437890
Provider Name (Legal Business Name): DONALD M MARKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 UNIVERSITY DR
STATE COLLEGE PA
16801-6552
US

IV. Provider business mailing address

611 UNIVERSITY DR SUITE 112
STATE COLLEGE PA
16801-6552
US

V. Phone/Fax

Practice location:
  • Phone: 814-234-0329
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS018302
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DONALD M MARKS
Title or Position: DENTIST
Credential: DMD
Phone: 814-234-0329