Healthcare Provider Details

I. General information

NPI: 1699971796
Provider Name (Legal Business Name): MARC LANDON BERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE SUITE 317
WASHINGTON DC
20017-2107
US

IV. Provider business mailing address

800 PRINCE FREDERICK BLVD
PRINCE FREDERICK MD
20678-3145
US

V. Phone/Fax

Practice location:
  • Phone: 202-636-1130
  • Fax:
Mailing address:
  • Phone: 410-535-2270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0050937
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: