Provider Demographics
NPI:1437314374
Name:MARQUES, MARY LOU
Entity Type:Individual
Prefix:MRS
First Name:MARY LOU
Middle Name:
Last Name:MARQUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CLUB AVENUE
Mailing Address - Street 2:
Mailing Address - City:ACUSHNET
Mailing Address - State:MA
Mailing Address - Zip Code:02743
Mailing Address - Country:US
Mailing Address - Phone:508-995-7855
Mailing Address - Fax:
Practice Address - Street 1:1980 ACUSHNET AVENUE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745
Practice Address - Country:US
Practice Address - Phone:508-995-7855
Practice Address - Fax:508-995-7161
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4003564332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment