Provider Demographics
NPI:1134114101
Name:MAMMERI, JUSTINA DEBELLA (CNM)
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:DEBELLA
Last Name:MAMMERI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SAINT PAUL PL
Mailing Address - Street 2:P.O.B. 501
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2102
Mailing Address - Country:US
Mailing Address - Phone:410-347-5700
Mailing Address - Fax:410-347-5744
Practice Address - Street 1:1838 GREENE TREE RD
Practice Address - Street 2:SUITE 380
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6391
Practice Address - Country:US
Practice Address - Phone:410-415-5577
Practice Address - Fax:410-415-6682
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR156307176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife