Provider Demographics
NPI:1679911713
Name:MARCELLUS R CEPHAS MD, LLC
Entity type:Organization
Organization Name:MARCELLUS R CEPHAS MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARCELLUS
Authorized Official - Middle Name:R
Authorized Official - Last Name:CEPHAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-891-2077
Mailing Address - Street 1:7610 CARROLL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6384
Mailing Address - Country:US
Mailing Address - Phone:301-891-2077
Mailing Address - Fax:301-891-2080
Practice Address - Street 1:7610 CARROLL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6384
Practice Address - Country:US
Practice Address - Phone:301-891-2077
Practice Address - Fax:301-891-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3762101YP2500X
MD115761041C0700X
MD179171041C0700X
MD043621041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty