Provider Demographics
NPI:1457313660
Name:MARCIC, TANIA S (MD)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:S
Last Name:MARCIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:920 PROVIDENCE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2976
Mailing Address - Country:US
Mailing Address - Phone:410-486-1010
Mailing Address - Fax:443-895-4822
Practice Address - Street 1:1838 GREENE TREE RD STE 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-7101
Practice Address - Country:US
Practice Address - Phone:410-486-1010
Practice Address - Fax:443-895-4822
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD207W00000X207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD511805100Medicaid
PA081211Medicare ID - Type Unspecified
MD511805100Medicaid
MDQ175Medicare PIN