Provider Demographics
NPI:1093460628
Name:MARLO, CHRISTOPHER GEORGE
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GEORGE
Last Name:MARLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 CORNWALL CT
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6183
Mailing Address - Country:US
Mailing Address - Phone:443-605-2557
Mailing Address - Fax:
Practice Address - Street 1:812 CORNWALL CT
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-6183
Practice Address - Country:US
Practice Address - Phone:443-605-2557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program