Healthcare Provider Details

I. General information

NPI: 1801123906
Provider Name (Legal Business Name): AMY MARQUIS SAGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 LASALLE RD 105
TOWSON MD
21286
US

IV. Provider business mailing address

8600 LASALLE RD, POTOMAC BUILDING SUITE 105
TOWSON MD
21286
US

V. Phone/Fax

Practice location:
  • Phone: 410-823-5232
  • Fax:
Mailing address:
  • Phone: 410-823-5232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0072389
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: