Provider Demographics
NPI:1720330566
Name:SAGEMAN, MARC SAMUEL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:SAMUEL
Last Name:SAGEMAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 KING FARM BLVD
Mailing Address - Street 2:SUITE 125-222
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5843
Mailing Address - Country:US
Mailing Address - Phone:301-990-8692
Mailing Address - Fax:
Practice Address - Street 1:507 GRAND CHAMPION DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-5791
Practice Address - Country:US
Practice Address - Phone:301-990-8692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00643562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry