Individual
MR. JEFFREY TAYAG MARUCUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5900 CEDAR LN, COLUMBIA, MD 21044
(443) 718-4067
Mailing address
5000 COX RD, GLEN ALLEN, VA 23060-9263
(804) 968-5700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0004856
MD
Other
Enumeration date
10/04/2012
Last updated
02/21/2022
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