Provider Demographics
NPI:1417942459
Name:TELESCO, DOROTHY ANN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:ANN
Last Name:TELESCO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 LOCKWOOD DR STE 325
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1589
Mailing Address - Country:US
Mailing Address - Phone:301-926-8879
Mailing Address - Fax:301-840-1246
Practice Address - Street 1:10801 LOCKWOOD DR STE 325
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1589
Practice Address - Country:US
Practice Address - Phone:301-926-8879
Practice Address - Fax:301-840-1246
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR136086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD328802100Medicaid
S83154Medicare UPIN
MD328802100Medicaid