Healthcare Provider Details

I. General information

NPI: 1447168620
Provider Name (Legal Business Name): MR. MARCUS DALLAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ATLANTIC ST SE APT 201
WASHINGTON DC
20032-3720
US

IV. Provider business mailing address

1319 S CAPITOL ST SW APT 1009
WASHINGTON DC
20003-5235
US

V. Phone/Fax

Practice location:
  • Phone: 202-603-6977
  • Fax:
Mailing address:
  • Phone: 202-603-6977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: