Individual provider Active NPI

Fred W. Markham, M.D.

  • Family Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1477579910
Registry record updated Sep 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD-019513-E Issued in PA
Practice address
833 Chestnut St
Suite 301
Philadelphia, PA 19107-4405
Phone
(215) 955-7190
Fax
(215) 923-9186
NPI assigned
Jul 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD-019513-E PA Primary
Obstetrics & Gynecology Physician 207V00000X MD-019513-E PA

Addresses

Primary practice location

833 Chestnut St
Suite 301
Philadelphia, PA 19107-4405

Mailing address

833 Chestnut Street
Suite 301
Philadelphia, PA 19107-4405
Phone (215) 955-7190

Other identifiers 1

IdentifierTypeStateIssuer
001290282MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050114000528 PA Practitioner - Family Practice 0446209696 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD-019513-EPAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians Family Medicine CurrentSince Aug 1, 1980 Accepting new patients

Locations

833 Chestnut St
Ste 301
Philadelphia, PA 19107
Phone (215) 955-2363

833 Chestnut St
Frnt 3
Philadelphia, PA 19107
Phone (215) 955-5800

1100 Walnut St
Fl 5
Philadelphia, PA 19107
Phone (215) 955-6750

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410220800000",
    "number": "1477579910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 CHESTNUT STREET",
            "address_2": "SUITE 301",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074405",
            "telephone_number": "215-955-7190",
            "fax_number": "215-923-9186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 CHESTNUT ST",
            "address_2": "SUITE 301",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074405",
            "telephone_number": "215-955-7190",
            "fax_number": "215-923-9186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARKHAM",
        "first_name": "FRED",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-15",
        "last_updated": "2014-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD-019513-E",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "PA",
            "license": "MD-019513-E",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001290282",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.