Provider Demographics
NPI:1679741821
Name:CHARLES B MAREK JR MD PA
Entity Type:Organization
Organization Name:CHARLES B MAREK JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:MAREK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:410-256-3200
Mailing Address - Street 1:9712 BELAIR RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1111
Mailing Address - Country:US
Mailing Address - Phone:410-256-3200
Mailing Address - Fax:410-529-2462
Practice Address - Street 1:9712 BELAIR RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-1111
Practice Address - Country:US
Practice Address - Phone:410-256-3200
Practice Address - Fax:410-529-2462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0013067207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDJ380OtherBLUE CHOICE
MD369AOtherBLUE SHIELD
MDJ380OtherBLUE CHOICE
MDE67757Medicare UPIN