Healthcare Provider Details

I. General information

NPI: 1336190248
Provider Name (Legal Business Name): ERIC CHARLES MARCALUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3168 BRAVERTON ST STE 250
EDGEWATER MD
21037-2682
US

IV. Provider business mailing address

3168 BRAVERTON ST SUITE 250
EDGEWATER MD
21037-2674
US

V. Phone/Fax

Practice location:
  • Phone: 410-956-1600
  • Fax: 410-956-7900
Mailing address:
  • Phone: 410-956-1600
  • Fax: 410-956-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD58166
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: