Healthcare Provider Details

I. General information

NPI: 1427471093
Provider Name (Legal Business Name): ADE MARCUS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2014
Last Update Date: 02/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 OLD COURT RD STE 105
RANDALLSTOWN MD
21133-5281
US

IV. Provider business mailing address

PO BOX 26513
BALTIMORE MD
21207-0313
US

V. Phone/Fax

Practice location:
  • Phone: 443-629-9243
  • Fax:
Mailing address:
  • Phone: 443-629-9243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR18213
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: