Healthcare Provider Details

I. General information

NPI: 1154256667
Provider Name (Legal Business Name): MADISON DIBELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 O ST NW
WASHINGTON DC
20057-0003
US

IV. Provider business mailing address

951 FELL ST APT 716
BALTIMORE MD
21231-3603
US

V. Phone/Fax

Practice location:
  • Phone: 202-687-0100
  • Fax:
Mailing address:
  • Phone: 860-841-3738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number337822
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: