Provider Demographics
NPI:1124127899
Name:DRISCOLL, MARCIA SANFORD (MD)
Entity type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:SANFORD
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:ELIZABETH
Other - Last Name:SANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 64445
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4445
Mailing Address - Country:US
Mailing Address - Phone:410-328-1064
Mailing Address - Fax:
Practice Address - Street 1:419 W REDWOOD ST
Practice Address - Street 2:SUITE 160
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1734
Practice Address - Country:US
Practice Address - Phone:410-328-3167
Practice Address - Fax:410-328-1323
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057983207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCS045-0033OtherBLUE SHIELD FEP
MD612547-01OtherCAREFIRST
P00452388Medicare PIN
DCS045-0033OtherBLUE SHIELD FEP
MDP277Medicare PIN