Healthcare Provider Details

I. General information

NPI: 1760489819
Provider Name (Legal Business Name): BARRY STEPHEN MARX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 05/03/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KIRK U.S. ARMY HEALTH CLINIC 6455 MACHINE STREET
ABERDEEN MD
21005-5000
US

IV. Provider business mailing address

3908 N CHARLES ST APT 901
BALTIMORE MD
21218-1752
US

V. Phone/Fax

Practice location:
  • Phone: 410-278-5475
  • Fax:
Mailing address:
  • Phone: 410-366-4594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0032422
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: