Provider Demographics
NPI:1972629350
Name:MARCUS, PAMELA ELLEN (RN APRN, PMH, BC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ELLEN
Last Name:MARCUS
Suffix:
Gender:F
Credentials:RN APRN, PMH, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:14460 OLD MILL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3092
Mailing Address - Country:US
Mailing Address - Phone:301-952-9286
Mailing Address - Fax:301-952-9287
Practice Address - Street 1:14460 OLD MILL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3092
Practice Address - Country:US
Practice Address - Phone:301-952-9286
Practice Address - Fax:301-952-9287
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR052316364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD786410800Medicaid
MD786410800Medicaid