Provider Demographics
NPI:1932157146
Name:BUARQUE DE MACEDO, ILENE S (MD)
Entity Type:Individual
Prefix:
First Name:ILENE
Middle Name:S
Last Name:BUARQUE DE MACEDO
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 1:6305 MOUNTAIN BRANCH COURT
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817
Mailing Address - Country:US
Mailing Address - Phone:301-320-6919
Mailing Address - Fax:
Practice Address - Street 1:1327 18TH STREET NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036
Practice Address - Country:US
Practice Address - Phone:202-785-2400
Practice Address - Fax:202-452-1853
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD18813174400000X
MDD0040982174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
E88654Medicare UPIN
DC663354Y59Medicare PIN