Provider Demographics
NPI:1033252390
Name:DAWN, MARIANNE E (MD)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:E
Last Name:DAWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7671 QUARTERFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4998
Mailing Address - Country:US
Mailing Address - Phone:410-766-0111
Mailing Address - Fax:410-582-9155
Practice Address - Street 1:7671 QUARTERFIELD ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:410-766-0111
Practice Address - Fax:410-582-9155
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430963207N00000X
MDD0071691207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA111267RHQMedicare PIN