Provider Demographics
NPI:1831221621
Name:MCKENZIE, MARLEEN (MD)
Entity type:Individual
Prefix:
First Name:MARLEEN
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5228 LIGHTFOOT PATH
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1102
Mailing Address - Country:US
Mailing Address - Phone:410-740-8133
Mailing Address - Fax:410-740-0281
Practice Address - Street 1:5228 LIGHTFOOT PATH
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-1102
Practice Address - Country:US
Practice Address - Phone:410-740-8133
Practice Address - Fax:410-740-0281
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055823207L00000X
DCMD 31551207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G96005Medicare UPIN
003390A21Medicare ID - Type Unspecified