Basic Information
| Provider Information | |||||||||
| NPI: | 1508399213 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAREK | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1427 CLARKVIEW RD STE 300E | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212092100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102960414 | ||||||||
| FaxNumber: | 4103540186 | ||||||||
| Practice Location | |||||||||
| Address1: | 1427 CLARKVIEW RD STE 300E | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212092100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102960414 | ||||||||
| FaxNumber: | 4103540186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2017 | ||||||||
| LastUpdateDate: | 02/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | D0090289 | MD | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.