Individual
MARQUIS LATRELL JESSIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1850 TOWN CENTER PKWY, SUITE 258, RESTON, VA 20190-3219
(703) 435-1454
Mailing address
1850 TOWN CENTER PKWY, SUITE 258, RESTON, VA 20190-3219
(703) 435-1454
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
A91999
CA
207VM0101X
Maternal & Fetal Medicine Physician
Primary
0101250972
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A91999
LICENSE
CA
Enumeration date
04/17/2007
Last updated
03/07/2023
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