MEDICARE: DR. FRED W. MARKHAM M.D.

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	MD-019513-E	PA
2	207V00000X	Obstetrics & Gynecology Physician	MD-019513-E	PA

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

General Provider Information

NPI Number	:	1477579910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED W. MARKHAM M.D.

Provider Business Mailing Address
First Line	:	833 CHESTNUT STREET
Second Line	:	SUITE 301
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4405
Country	:	US
Telephone Number	:	215-955-7190
Fax Number	:	215-923-9186

Provider Business Practice Location Address
First Line	:	833 CHESTNUT ST
Second Line	:	SUITE 301
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4405
Country	:	US
Telephone Number	:	215-955-7190
Fax Number	:	215-923-9186

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

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	09/09/2014

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