Provider Demographics
NPI:1982009429
Name:HOLMES, MARQUITA
Entity Type:Individual
Prefix:
First Name:MARQUITA
Middle Name:
Last Name:HOLMES
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 1:3060 ROUTE 97 STE 290
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21738-9738
Mailing Address - Country:US
Mailing Address - Phone:410-942-6467
Mailing Address - Fax:
Practice Address - Street 1:3060 ROUTE 97 STE 290
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MD
Practice Address - Zip Code:21738-9738
Practice Address - Country:US
Practice Address - Phone:410-942-6467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator