Provider Demographics
NPI:1447256664
Name:MARKS, EDWARD ROBERT III (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:ROBERT
Last Name:MARKS
Suffix:III
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 1:40 MEDICAL PARK STE 406
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6392
Mailing Address - Country:US
Mailing Address - Phone:304-243-3330
Mailing Address - Fax:304-243-3231
Practice Address - Street 1:1006 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:WELLSBURG
Practice Address - State:WV
Practice Address - Zip Code:26070-1567
Practice Address - Country:US
Practice Address - Phone:304-737-4435
Practice Address - Fax:304-737-4439
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0055301000Medicaid
OH2073429Medicaid
WV0849582Medicare PIN
OH2073429Medicaid