Provider Demographics
NPI:1720342991
Name:CHEGNUI, MARCEL
Entity Type:Individual
Prefix:
First Name:MARCEL
Middle Name:
Last Name:CHEGNUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-1740
Mailing Address - Country:US
Mailing Address - Phone:410-225-2091
Mailing Address - Fax:410-669-8790
Practice Address - Street 1:2509 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-1740
Practice Address - Country:US
Practice Address - Phone:410-225-2091
Practice Address - Fax:410-669-8790
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
MD27010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No374U00000XNursing Service Related ProvidersHome Health Aide