Provider Demographics
NPI:1376594010
Name:DEFRANCESCO-MALVIYA, MARIE ANN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ANN
Last Name:DEFRANCESCO-MALVIYA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:ANN
Other - Last Name:DEFRANCESCO-LOUKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:410-955-8309
Practice Address - Street 1:5450 KNOLL NORTH DR STE 301
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2373
Practice Address - Country:US
Practice Address - Phone:443-546-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-536142163W00000X
MDR208342363L00000X, 367500000X
NY332252363L00000X
PASP007322363L00000X
PA081633367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA079816Medicare PIN