Healthcare Provider Details

I. General information

NPI: 1538579677
Provider Name (Legal Business Name): MARJA BOOKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PICCARD DR 1400
ROCKVILLE MD
20850-4320
US

IV. Provider business mailing address

1301 PICCARD DRIVE
ROCKVILLE MD
20850
US

V. Phone/Fax

Practice location:
  • Phone: 240-777-4854
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC1473
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: