Healthcare Provider Details

I. General information

NPI: 1649181249
Provider Name (Legal Business Name): MARISSA CHUCK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7335 HANOVER PKWY STE B
GREENBELT MD
20770-3623
US

IV. Provider business mailing address

8900 COLUMBIA 100 PKWY STE E
COLUMBIA MD
21045-2336
US

V. Phone/Fax

Practice location:
  • Phone: 443-218-6154
  • Fax:
Mailing address:
  • Phone: 443-380-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: