1285621094 NPI number — DR. CHARLES B MAREK JR. MD

Table of content: DR. CHARLES B MAREK JR. MD (NPI 1285621094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285621094 NPI number — DR. CHARLES B MAREK JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAREK
Provider First Name:
CHARLES
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285621094
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9712 BELAIR RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21236-1103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-256-3200
Provider Business Mailing Address Fax Number:
440-529-2462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4021 BAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLE RIVER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21220-4036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-916-4090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  D0013064 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 369A . This is a "BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: J380 . This is a "BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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