Provider Demographics
NPI:1669170122
Name:QUARLES, MARIA MARTA (CLC)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:MARTA
Last Name:QUARLES
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 FARMSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-8329
Mailing Address - Country:US
Mailing Address - Phone:240-863-1334
Mailing Address - Fax:
Practice Address - Street 1:2028 LIBERTY RD STE 103
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-5079
Practice Address - Country:US
Practice Address - Phone:410-598-4336
Practice Address - Fax:443-280-6441
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDALPP-335-810174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN