Healthcare Provider Details

I. General information

NPI: 1174223218
Provider Name (Legal Business Name): TAYLOR MARMORALE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEDICAL PKWY STE 600
ANNAPOLIS MD
21401-3748
US

IV. Provider business mailing address

2000 MEDICAL PKWY STE 600
ANNAPOLIS MD
21401-3748
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-6699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1204187
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: