Provider Demographics
NPI:1730822750
Name:MIDGETTE, MARCUS ALLEN (RMP)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:ALLEN
Last Name:MIDGETTE
Suffix:
Gender:M
Credentials:RMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8758 JARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3836
Mailing Address - Country:US
Mailing Address - Phone:410-344-3551
Mailing Address - Fax:
Practice Address - Street 1:36 S CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-3020
Practice Address - Country:US
Practice Address - Phone:410-498-7844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR02610111N00000X, 163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)Group - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractor