Provider Demographics
NPI:1588779672
Name:MARCUS, ROGER W (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:W
Last Name:MARCUS
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 1:1814 BEL AIR RD
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2734
Mailing Address - Country:US
Mailing Address - Phone:410-877-0271
Mailing Address - Fax:410-877-0274
Practice Address - Street 1:1814 BEL AIR RD
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2734
Practice Address - Country:US
Practice Address - Phone:410-877-0271
Practice Address - Fax:410-877-0274
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23646207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD777011100Medicaid
D76286Medicare UPIN