Provider Demographics
NPI:1447775606
Name:HAM, MARQUIS SHANTEL
Entity Type:Individual
Prefix:MS
First Name:MARQUIS
Middle Name:SHANTEL
Last Name:HAM
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 1:6421 STRAIGHTSTONE RD
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND
Mailing Address - State:VA
Mailing Address - Zip Code:24569-2839
Mailing Address - Country:US
Mailing Address - Phone:434-713-1738
Mailing Address - Fax:434-299-3002
Practice Address - Street 1:6421 STRAIGHTSTONE RD
Practice Address - Street 2:
Practice Address - City:LONG ISLAND
Practice Address - State:VA
Practice Address - Zip Code:24569-2839
Practice Address - Country:US
Practice Address - Phone:434-713-1738
Practice Address - Fax:434-299-3002
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)