Healthcare Provider Details

I. General information

NPI: 1538548664
Provider Name (Legal Business Name): MARCELLUS R. CEPHAS, MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 MADISON PARK DR SUITE 1B
GLEN BURNIE MD
21061-5627
US

IV. Provider business mailing address

7610 CARROLL AVE STE 200
TAKOMA PARK MD
20912-6312
US

V. Phone/Fax

Practice location:
  • Phone: 410-487-6302
  • Fax: 301-891-2080
Mailing address:
  • Phone: 301-891-2077
  • Fax: 301-891-2080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. MARCELLUS CEPHAS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 301-891-2077