MEDICARE: DR. MARIE-ALBERTE BOURSIQUOT M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D0051958	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	547529-10	OTHER	MD	CAREFIRST-MD
2	0045	OTHER	MD	CAREFIRST-REGIONAL

General Provider Information

NPI Number	:	1578571618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIE-ALBERTE BOURSIQUOT M.D

Provider Business Mailing Address
First Line	:	4801 DORSEY HALL DR STE 201
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7749
Country	:	US
Telephone Number	:	410-997-7660
Fax Number	:	410-884-0063

Provider Business Practice Location Address
First Line	:	4801 DORSEY HALL DR STE 201
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7749
Country	:	US
Telephone Number	:	410-997-7660
Fax Number	:	410-884-0063

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	06/07/2021

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Directions to “ DR. MARIE-ALBERTE BOURSIQUOT M.D” Practice Location

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