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General NPI Number Information
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NPI Number | 1013435387
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Entity Type | Individual
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Provider Name | MARCUS MOTTON
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Gender | Male
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Dates
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Enumeration Date | 09/06/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5629 HARFORD ROAD
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City | BALTIMORE
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State | MD
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Zip | 21214
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Country | US
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Telephone | 410-444-0204
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Fax | 410-444-0124
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Provider Business Mailing Address
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Address Line | 5629 HARFORD RD
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City | BALTIMORE
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State | MD
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Zip | 21214-2272
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Country | US
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Telephone | 410-444-0204
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Fax | 410-444-0124
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 30-033-A
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License Number State | MD
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