Healthcare Provider Details

I. General information

NPI: 1740532977
Provider Name (Legal Business Name): MANUEL MARQUEZ FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 KINGS HIGHWAY CUTOFF STE 3A
FAIRFIELD CT
06824-5340
US

IV. Provider business mailing address

11350 MCCORMICK RD EXECUTIVE PLAZA 1, STE. 501
HUNT VALLEY MD
21031-2313
US

V. Phone/Fax

Practice location:
  • Phone: 203-373-7330
  • Fax:
Mailing address:
  • Phone: 703-914-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF337207-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: