Provider Demographics
NPI:1174595532
Name:MARKS, GERALD J (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:J
Last Name:MARKS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:SUITE 330 LANKENAU MOB WEST
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-645-9093
Mailing Address - Fax:610-645-9476
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:SUITE 330 LANKENAU MOB WEST
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-645-9093
Practice Address - Fax:610-645-9476
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD023151L208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C26583Medicare UPIN
PA232359401OtherMAIN LINE HEALTHCARE
PA000778440Medicaid
PA011732M87Medicare PIN