Provider Demographics
NPI:1376682906
Name:ELDRIDGE, MARLO ANN MICHELL (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:MARLO
Middle Name:ANN MICHELL
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:CPNP
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Mailing Address - Street 1:5004 BRAMPTON PKWY
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-7423
Mailing Address - Country:US
Mailing Address - Phone:410-465-5104
Mailing Address - Fax:410-614-0789
Practice Address - Street 1:601 N CAROLINE ST
Practice Address - Street 2:OFFICE #4035
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0006
Practice Address - Country:US
Practice Address - Phone:410-614-6327
Practice Address - Fax:410-614-0789
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR134853363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics