Healthcare Provider Details

I. General information

NPI: 1992177851
Provider Name (Legal Business Name): MARINA GETHERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 FREDERICK AVE
BALTIMORE MD
21229-3218
US

IV. Provider business mailing address

1208 E CHURCHVILLE RD STE
BEL AIR MD
21014-3442
US

V. Phone/Fax

Practice location:
  • Phone: 410-893-4600
  • Fax: 443-640-4358
Mailing address:
  • Phone: 410-893-4600
  • Fax: 443-640-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9042
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: