Provider Demographics
NPI:1003087636
Name:ROGER W. MARCUS, M.D., PA
Entity Type:Organization
Organization Name:ROGER W. MARCUS, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, ROGER W. MARCUS M.D. ,PA
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:W
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-877-0271
Mailing Address - Street 1:1814 BEL AIR RD
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2734
Mailing Address - Country:US
Mailing Address - Phone:410-877-0271
Mailing Address - Fax:410-877-0274
Practice Address - Street 1:1814 BEL AIR RD
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2734
Practice Address - Country:US
Practice Address - Phone:410-877-0271
Practice Address - Fax:410-877-0274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23646261QM2500X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0469000001Medicare NSC