Provider Demographics
NPI:1629463898
Name:MERMELSTEIN, MARCUS SAMUEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:SAMUEL
Last Name:MERMELSTEIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 WISCONSIN AVE BLDG 9A FL 3, SURGICAL ICU
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-0001
Mailing Address - Country:US
Mailing Address - Phone:301-400-0018
Mailing Address - Fax:
Practice Address - Street 1:8901 WISCONSIN AVE BLDG 9A FL 3, SURGICAL ICU
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5367
Practice Address - Country:US
Practice Address - Phone:301-400-0018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0007408363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant