Healthcare Provider Details

I. General information

NPI: 1588779672
Provider Name (Legal Business Name): ROGER W MARCUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 BEL AIR RD
FALLSTON MD
21047-2734
US

IV. Provider business mailing address

1814 BEL AIR RD
FALLSTON MD
21047-2734
US

V. Phone/Fax

Practice location:
  • Phone: 410-877-0271
  • Fax: 410-877-0274
Mailing address:
  • Phone: 410-877-0271
  • Fax: 410-877-0274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberD23646
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: