Provider Demographics
NPI:1750482204
Name:STALCUP, MARSHA GAIL (CNM)
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:GAIL
Last Name:STALCUP
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:904 HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6821
Mailing Address - Country:US
Mailing Address - Phone:301-806-3883
Mailing Address - Fax:301-587-0444
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW
Practice Address - Street 2:5TH FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-741-2500
Practice Address - Fax:202-741-2562
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN961133367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3R8630Medicare UPIN