Healthcare Provider Details

I. General information

NPI: 1093656217
Provider Name (Legal Business Name): MARAVIA MONTIA MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 E NORTH AVE # 12
BALTIMORE MD
21202-5909
US

IV. Provider business mailing address

3403 MEADOWDALE DR
WINDSOR MILL MD
21244-2237
US

V. Phone/Fax

Practice location:
  • Phone: 443-468-7929
  • Fax:
Mailing address:
  • Phone: 443-468-7929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberL27039247
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: