Provider Demographics
NPI:1750911798
Name:DIABETES SELF CARE MANAGEMENT INSTITUTE, LLC
Entity type:Organization
Organization Name:DIABETES SELF CARE MANAGEMENT INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MADIKOTO
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:301-245-3082
Mailing Address - Street 1:3311 TOLEDO TER STE B103
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-8146
Mailing Address - Country:US
Mailing Address - Phone:301-245-3082
Mailing Address - Fax:301-978-7986
Practice Address - Street 1:3311 TOLEDO TER STE B103
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-8146
Practice Address - Country:US
Practice Address - Phone:301-245-3082
Practice Address - Fax:301-978-7986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Single Specialty