Basic Information
| Provider Information | |||||||||
| NPI: | 1023061769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARKS | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 470 HULON LANE | ||||||||
| Address2: | ATTN: VP - REVENUE CYCLE | ||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039367966 | ||||||||
| FaxNumber: | 8039367938 | ||||||||
| Practice Location | |||||||||
| Address1: | 146 E HOSPITAL DR STE 140&350 | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291694800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039367966 | ||||||||
| FaxNumber: | 8039367938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 07/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 83936 | SC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 002000226F | 01 | HUMANA | OTHER | 1023061769 | 05 | WI | MEDICAID |