Provider Demographics
NPI:1093176117
Name:DIABETES SELF CARE MANAGEMENT INSTITUTE, LLC
Entity Type:Organization
Organization Name:DIABETES SELF CARE MANAGEMENT INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MADIKOTO
Authorized Official - Suffix:
Authorized Official - Credentials:C-FNP, CDE
Authorized Official - Phone:301-992-8243
Mailing Address - Street 1:3311 TOLEDO TER STE B103
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-8146
Mailing Address - Country:US
Mailing Address - Phone:301-992-8243
Mailing Address - Fax:301-978-7986
Practice Address - Street 1:3311 TOLEDO TER STE B103
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-8146
Practice Address - Country:US
Practice Address - Phone:301-992-8243
Practice Address - Fax:301-978-7986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty