Healthcare Provider Details

I. General information

NPI: 1003087636
Provider Name (Legal Business Name): ROGER W. MARCUS, M.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 11/08/2013
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 Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberD23646
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberD23646
License Number StateMD

VIII. Authorized Official

Name: DR. ROGER W. MARCUS
Title or Position: PRESIDENT, ROGER W. MARCUS M.D. ,PA
Credential: M..D.
Phone: 410-877-0271