Provider Demographics
NPI:1376233957
Name:MARCUS, JAYDEN ISIAH
Entity Type:Individual
Prefix:
First Name:JAYDEN
Middle Name:ISIAH
Last Name:MARCUS
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 1:7060 OAKLAND MILLS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1694
Mailing Address - Country:US
Mailing Address - Phone:410-831-5642
Mailing Address - Fax:
Practice Address - Street 1:3286 CORPORATE CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2284
Practice Address - Country:US
Practice Address - Phone:410-831-5642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty