Provider Demographics
NPI:1992584536
Name:LEMUS, MARILI
Entity type:Individual
Prefix:
First Name:MARILI
Middle Name:
Last Name:LEMUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4810
Mailing Address - Country:US
Mailing Address - Phone:443-562-2729
Mailing Address - Fax:
Practice Address - Street 1:8100 SANDPIPER CIR STE 308
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4992
Practice Address - Country:US
Practice Address - Phone:410-918-0777
Practice Address - Fax:866-701-4905
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0009273363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant