Basic Information
Provider Information
NPI: 1083672331
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TREESE
FirstName: MARNEY
MiddleName: B
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1300 PICCARD DRIVE
Address2: SUITE 202
City: ROCKVILLE
State: MD
PostalCode: 208504303
CountryCode: US
TelephoneNumber: 3019217900
FaxNumber: 3019217915
Practice Location
Address1: 200 MEMORIAL AVENUE
Address2: CARROLL HOSPITAL CENTER
City: WESTMINSTER
State: MD
PostalCode: 211575799
CountryCode: US
TelephoneNumber: 4108716700
FaxNumber: 4108717177
Other Information
ProviderEnumerationDate: 05/03/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XD63363MDY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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