Provider Demographics
NPI:1548235682
Name:MARSH, MARVA A (PT)
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:A
Last Name:MARSH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 MERCANTILE LANE
Mailing Address - Street 2:#160
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5380
Mailing Address - Country:US
Mailing Address - Phone:301-583-0150
Mailing Address - Fax:301-583-0348
Practice Address - Street 1:1100 MERCANTILE LANE
Practice Address - Street 2:#160
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5380
Practice Address - Country:US
Practice Address - Phone:301-583-0150
Practice Address - Fax:301-583-0348
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16313174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD147057500OtherDEPT PF LABOR WORKERS COM
DCS4740001OtherBLUE CROSS BLUE SHIELD
228752OtherMAMSI ALLIANCE PPO MDIPA
MD650011408OtherRAILROAD MEDICARE
MD597163Medicare ID - Type Unspecified