Provider Demographics
NPI:1376541623
Name:MAGDAY, JOSELITO DURAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSELITO
Middle Name:DURAN
Last Name:MAGDAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7994 MARTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1148
Mailing Address - Country:US
Mailing Address - Phone:301-953-7346
Mailing Address - Fax:
Practice Address - Street 1:11701 ROBY AVE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-1509
Practice Address - Country:US
Practice Address - Phone:301-937-5452
Practice Address - Fax:301-937-5453
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2010-02-19
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-06-15
Provider Licenses
StateLicense IDTaxonomies
MDD013687207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD016981100Medicaid
MDB93812Medicare UPIN
MD016981100Medicaid