Provider Demographics
NPI:1356516470
Name:MARLENE G DESAMITO M D L L C
Entity type:Organization
Organization Name:MARLENE G DESAMITO M D L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:G
Authorized Official - Last Name:DESAMITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-463-1547
Mailing Address - Street 1:3311 TOLEDO TER
Mailing Address - Street 2:SUITE C 105
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-4135
Mailing Address - Country:US
Mailing Address - Phone:301-559-2515
Mailing Address - Fax:301-559-2517
Practice Address - Street 1:3311 TOLEDO TER
Practice Address - Street 2:SUITE C105
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-4135
Practice Address - Country:US
Practice Address - Phone:301-559-2515
Practice Address - Fax:301-559-2517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053700261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care