Provider Demographics
NPI:1194948935
Name:CARSON, MARCUS THOMAS (PD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:THOMAS
Last Name:CARSON
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3827 JANBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-2705
Mailing Address - Country:US
Mailing Address - Phone:443-904-3025
Mailing Address - Fax:410-521-5875
Practice Address - Street 1:7153 SECURITY BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-1811
Practice Address - Country:US
Practice Address - Phone:410-944-6400
Practice Address - Fax:410-944-2492
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist