Provider Demographics
NPI:1639107097
Name:LORENZO, MARLYN (MD)
Entity Type:Individual
Prefix:
First Name:MARLYN
Middle Name:
Last Name:LORENZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 STEVENS FOREST RD STE 101
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3240
Mailing Address - Country:US
Mailing Address - Phone:410-992-7440
Mailing Address - Fax:443-276-0349
Practice Address - Street 1:6350 STEVENS FOREST RD STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046
Practice Address - Country:US
Practice Address - Phone:410-992-7440
Practice Address - Fax:410-992-4441
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO63393207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408167600Medicaid
MD408167600Medicaid
303M / M264Medicare ID - Type Unspecified
MDKAZ 1 / 646078-01OtherBC / BS OF MD
MDS 186 / 0103OtherBLUECHOICE