Healthcare Provider Details

I. General information

NPI: 1568519189
Provider Name (Legal Business Name): ROBERT F MARCUS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 STATE ROUTE 108 OAKLAND CENTER
COLUMBIA MD
21045-1951
US

IV. Provider business mailing address

9030 STATE ROUTE 108 OAKLAND CENTER
COLUMBIA MD
21045-1951
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-1901
  • Fax: 410-740-2503
Mailing address:
  • Phone: 410-740-1901
  • Fax: 410-740-2503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number01292
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: