MEDICARE: EDWARD ROBERT MARKS III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	18806	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447256664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD ROBERT MARKS III MD

Provider Business Mailing Address
First Line	:	40 MEDICAL PARK STE 406
Second Line	:
City	:	WHEELING
State	:	WV
Zip	:	26003-6392
Country	:	US
Telephone Number	:	304-243-3330
Fax Number	:	304-243-3231

Provider Business Practice Location Address
First Line	:	1006 COMMERCE ST
Second Line	:
City	:	WELLSBURG
State	:	WV
Zip	:	26070-1567
Country	:	US
Telephone Number	:	304-737-4435
Fax Number	:	304-737-4439

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	01/12/2011

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