Provider Demographics
NPI:1508807298
Name:MAMODESENE, DORA M (MD)
Entity Type:Individual
Prefix:DR
First Name:DORA
Middle Name:M
Last Name:MAMODESENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10490
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20914
Mailing Address - Country:US
Mailing Address - Phone:301-989-1335
Mailing Address - Fax:301-989-2276
Practice Address - Street 1:7733 ALASKA AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012
Practice Address - Country:US
Practice Address - Phone:202-882-5300
Practice Address - Fax:301-989-1335
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0029649207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC148491Medicare PIN