Provider Demographics
NPI:1285621094
Name:MARCK, CHARLES B JR (MD)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:B
Last Name:MARCK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9712 BELAIR RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1103
Mailing Address - Country:US
Mailing Address - Phone:410-256-3200
Mailing Address - Fax:440-529-2462
Practice Address - Street 1:9712 BELAIR RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-1103
Practice Address - Country:US
Practice Address - Phone:410-256-3200
Practice Address - Fax:440-529-2462
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0013064207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD369AOtherBLUE SHIELD
MDJ380OtherBLUE CHOICE
E67757Medicare UPIN
MA856MMedicare ID - Type Unspecified