Healthcare Provider Details

I. General information

NPI: 1285581249
Provider Name (Legal Business Name): MARIEN TIKUM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8619 ANNAPOLIS RD APT 102
NEW CARROLLTON MD
20784-3104
US

IV. Provider business mailing address

8619 ANNAPOLIS RD APT 102
NEW CARROLLTON MD
20784-3104
US

V. Phone/Fax

Practice location:
  • Phone: 227-284-9155
  • Fax:
Mailing address:
  • Phone: 227-284-9155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00219853
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: