Basic Information
Provider Information
NPI: 1558319228
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DANA
FirstName: MARCUS
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: CRNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7402 OSLER DRIVE
Address2: SUITE 200
City: TOWSON
State: MD
PostalCode: 21014
CountryCode: US
TelephoneNumber: 4108217471
FaxNumber: 4108219582
Practice Location
Address1: SAINT JOSEPH MEDICAL CENTER
Address2: 7601 OSLER DRIVE
City: TOWSON
State: MD
PostalCode: 21204
CountryCode: US
TelephoneNumber: 4103371226
FaxNumber: 4103371118
Other Information
ProviderEnumerationDate: 05/05/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XR131677MDY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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