Provider Demographics
NPI:1184764060
Name:MARX, JOHN H (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:MARX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 VIEWMONT DRIVE
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519-1664
Mailing Address - Country:US
Mailing Address - Phone:570-346-1464
Mailing Address - Fax:570-558-9051
Practice Address - Street 1:920 VIEWMONT DRIVE
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1664
Practice Address - Country:US
Practice Address - Phone:570-346-1464
Practice Address - Fax:570-558-9051
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433342208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020742490001Medicaid
PA1020742490001Medicaid