Provider Demographics
NPI:1851687750
Name:DISTEFANO, YOUMNA EDMA (MD)
Entity Type:Individual
Prefix:DR
First Name:YOUMNA
Middle Name:EDMA
Last Name:DISTEFANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PIERSIDE DR APT 127
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-5466
Mailing Address - Country:US
Mailing Address - Phone:617-314-0603
Mailing Address - Fax:
Practice Address - Street 1:550 N BROADWAY STE 301
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-2004
Practice Address - Country:US
Practice Address - Phone:410-955-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program