Provider Demographics
NPI:1346460060
Name:SOULSMAN, MARCIA R (NP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:R
Last Name:SOULSMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARICA
Other - Middle Name:
Other - Last Name:SOULSMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:4 CAROLINA AVENUE
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-5404
Mailing Address - Country:US
Mailing Address - Phone:301-261-7523
Mailing Address - Fax:410-956-4341
Practice Address - Street 1:4 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-5404
Practice Address - Country:US
Practice Address - Phone:301-261-7523
Practice Address - Fax:410-956-4341
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR087625363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD687001500Medicaid
P31858Medicare UPIN
MD635RMedicare ID - Type Unspecified