Provider Demographics
NPI:1619916251
Name:MARQUEZ, JAIME FRANZ (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:FRANZ
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 CARROLL AVE
Mailing Address - Street 2:#350
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6384
Mailing Address - Country:US
Mailing Address - Phone:301-891-6040
Mailing Address - Fax:301-891-0730
Practice Address - Street 1:7610 CARROLL AVE
Practice Address - Street 2:#350
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6384
Practice Address - Country:US
Practice Address - Phone:301-891-6040
Practice Address - Fax:301-891-0730
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD26265174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD264551300Medicaid
MDC88486Medicare UPIN
MD264551300Medicaid