Provider Demographics
NPI:1164899084
Name:ADORE-LEWIS, MARLENE L (PT)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:L
Last Name:ADORE-LEWIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7404 EXECUTIVE PL STE 300B
Mailing Address - Street 2:300B
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-6215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7404 EXECUTIVE PL STE 300B
Practice Address - Street 2:300B
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-6215
Practice Address - Country:US
Practice Address - Phone:301-599-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18044363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical