Provider Demographics
NPI:1437754389
Name:YOUR DIABETES NP, LLC
Entity Type:Organization
Organization Name:YOUR DIABETES NP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:502-432-8744
Mailing Address - Street 1:11705 BERRY RD STE 301-3
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-5933
Mailing Address - Country:US
Mailing Address - Phone:301-799-5850
Mailing Address - Fax:
Practice Address - Street 1:11705 BERRY RD STE 301-3
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-5933
Practice Address - Country:US
Practice Address - Phone:301-799-5850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty