Provider Demographics
NPI:1366417289
Name:ACKERMAN, R MARSHALL (MD)
Entity type:Individual
Prefix:DR
First Name:R
Middle Name:MARSHALL
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 BLACKWELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6477
Mailing Address - Country:US
Mailing Address - Phone:301-340-9200
Mailing Address - Fax:301-340-6934
Practice Address - Street 1:9601 BLACKWELL RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6477
Practice Address - Country:US
Practice Address - Phone:301-340-9200
Practice Address - Fax:301-340-6934
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0002443207X00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD200008826OtherMEDICARE RAILROAD
MD0001OtherBLUE SHIELD OF NCA
MD410043OtherBLUE SHIELD OF MARYLAND
MD1080142007OtherCIGNA
MD492968OtherNCPPO
MD225302OtherMAMSI
MD492968OtherNCPPO
MD225302OtherMAMSI