Provider Demographics
NPI:1013010198
Name:DAMD, INC
Entity Type:Organization
Organization Name:DAMD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BERNAL-CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN,BC
Authorized Official - Phone:410-641-1117
Mailing Address - Street 1:P.O. BOX 2497
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-2497
Mailing Address - Country:US
Mailing Address - Phone:443-260-2660
Mailing Address - Fax:443-260-2754
Practice Address - Street 1:331 BUTTERCUP CT
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811
Practice Address - Country:US
Practice Address - Phone:410-713-2353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405537300Medicaid
DE1000036290Medicaid
MDQ21504Medicare UPIN
DEG02383Medicare PIN
MD405537300Medicaid