Provider Demographics
NPI:1861469686
Name:DECONCINI, DENISE M (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:DECONCINI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:12301 OLD COLUMBIA PIKE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904
Mailing Address - Country:US
Mailing Address - Phone:301-625-2800
Mailing Address - Fax:301-625-9046
Practice Address - Street 1:12301 OLD COLUMBIA PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904
Practice Address - Country:US
Practice Address - Phone:301-625-2800
Practice Address - Fax:301-625-9046
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2020-07-15
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Provider Licenses
StateLicense IDTaxonomies
MDD0040685208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD093751700Medicaid