Healthcare Provider Details

I. General information

NPI: 1013435387
Provider Name (Legal Business Name): MARCUS MOTTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5629 HARFORD ROAD
BALTIMORE MD
21214
US

IV. Provider business mailing address

5629 HARFORD RD
BALTIMORE MD
21214-2272
US

V. Phone/Fax

Practice location:
  • Phone: 410-444-0204
  • Fax: 410-444-0124
Mailing address:
  • Phone: 410-444-0204
  • Fax: 410-444-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number30-033-A
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: