Provider Demographics
NPI:1215489505
Name:MARSHALL, DAMON LAMONT SR (RN)
Entity type:Individual
Prefix:
First Name:DAMON
Middle Name:LAMONT
Last Name:MARSHALL
Suffix:SR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 GRAND CENTRAL AVE
Mailing Address - Street 2:APT 318
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3995
Mailing Address - Country:US
Mailing Address - Phone:443-850-4740
Mailing Address - Fax:866-287-0435
Practice Address - Street 1:10301 GRAND CENTRAL AVE
Practice Address - Street 2:APT 318
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3995
Practice Address - Country:US
Practice Address - Phone:443-850-4740
Practice Address - Fax:866-287-0435
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR205534163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical