Healthcare Provider Details

I. General information

NPI: 1639540982
Provider Name (Legal Business Name): MARIE LO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date: 08/27/2025
Reactivation Date: 09/11/2025

III. Provider practice location address

7661 ARUNDEL MILLS BLVD # 1039
HANOVER MD
21076-1305
US

IV. Provider business mailing address

5133 PARK HEIGHTS AVE
BALTIMORE MD
21215-5816
US

V. Phone/Fax

Practice location:
  • Phone: 201-238-3796
  • Fax:
Mailing address:
  • Phone: 201-238-3796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR247223
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: