MEDICARE: MRS. PAMELA ELLEN MARCUS RN APRN, PMH, BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	R052316	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972629350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAMELA ELLEN MARCUS RN APRN, PMH, BC

Provider Business Mailing Address
First Line	:	14460 OLD MILL RD
Second Line	:	SUITE 201
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-3092
Country	:	US
Telephone Number	:	301-952-9286
Fax Number	:	301-952-9287

Provider Business Practice Location Address
First Line	:	14460 OLD MILL RD
Second Line	:	SUITE 201
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-3092
Country	:	US
Telephone Number	:	301-952-9286
Fax Number	:	301-952-9287

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	10/17/2011

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