Provider Demographics
NPI:1710976816
Name:WHALL, MARGUERITE KELLY (NP)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:KELLY
Last Name:WHALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15529 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-3955
Mailing Address - Country:US
Mailing Address - Phone:301-989-1795
Mailing Address - Fax:301-989-8483
Practice Address - Street 1:11065 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2998
Practice Address - Country:US
Practice Address - Phone:410-730-5700
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR056855363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health