Provider Demographics
NPI:1801524236
Name:TOMO, MARIE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:TOMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9863 BROOKRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-1109
Mailing Address - Country:US
Mailing Address - Phone:301-291-8777
Mailing Address - Fax:
Practice Address - Street 1:9863 BROOKRIDGE CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-1109
Practice Address - Country:US
Practice Address - Phone:301-291-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0118533376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide