Provider Demographics
NPI:1659752467
Name:MARCELLUS R CEPHAS MD LLC
Entity type:Organization
Organization Name:MARCELLUS R CEPHAS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCELLUS
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:CEPHAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-891-2077
Mailing Address - Street 1:7610 CARROLL AVENUE, SUITE 470
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6312
Mailing Address - Country:US
Mailing Address - Phone:301-891-2077
Mailing Address - Fax:301-576-7397
Practice Address - Street 1:7610 CARROLL AVENUE, SUITE 470
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6312
Practice Address - Country:US
Practice Address - Phone:301-891-2077
Practice Address - Fax:301-576-7397
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARCELLUS R CEPHAS MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-17
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3762101YM0800X
MD179171041C0700X
MD138141041C0700X
363LP0808X
MDD0059532103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG01202OtherP/10
MD1659752467Medicaid