Provider Demographics
NPI:1841296407
Name:DAIDONE, MARA J (MD)
Entity type:Individual
Prefix:DR
First Name:MARA
Middle Name:J
Last Name:DAIDONE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 HOSPITAL RD
Mailing Address - Street 2:ATTN: AMY GRASSEY
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4017
Mailing Address - Country:US
Mailing Address - Phone:410-414-4791
Mailing Address - Fax:410-414-4765
Practice Address - Street 1:110 HOSPITAL RD
Practice Address - Street 2:SUITE 304
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4019
Practice Address - Country:US
Practice Address - Phone:410-535-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0055201207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH03255Medicare UPIN