Healthcare Provider Details

I. General information

NPI: 1710976816
Provider Name (Legal Business Name): MARGUERITE KELLY WHALL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11065 LITTLE PATUXENT PKWY SUITE 200
COLUMBIA MD
21044-2998
US

IV. Provider business mailing address

15529 THOMPSON RD
SILVER SPRING MD
20905-3955
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-5700
  • Fax:
Mailing address:
  • Phone: 301-989-1795
  • Fax: 301-989-8483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR056855
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: