MEDICARE: MARK MARCELLUS BOOKER

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	3747A0650X	Attendant Care Provider
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1982439352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK MARCELLUS BOOKER

Provider Business Mailing Address
First Line	:	10095 WASHING BLVD
Second Line	:	529
City	:	LAUREL
State	:	MD
Zip	:	20743
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10095 WASHINGTON BLVD N APT 529
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20723-1963
Country	:	US
Telephone Number	:	202-993-6995
Fax Number	:

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

Provider Enumeration Date	:	09/05/2024
Last Update Date	:	09/05/2024

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Directions to “ MARK MARCELLUS BOOKER ” Practice Location

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