Provider Demographics
NPI:1710672589
Name:SAM, MARSHA DENISE
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:DENISE
Last Name:SAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 HEATH ST
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-5927
Mailing Address - Country:US
Mailing Address - Phone:202-702-7318
Mailing Address - Fax:
Practice Address - Street 1:2954 NASH PL SE APT 104
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-7752
Practice Address - Country:US
Practice Address - Phone:202-702-7318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant