Healthcare Provider Details

I. General information

NPI: 1508334368
Provider Name (Legal Business Name): MARTHA MARIA QUEZADO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 ROCKVILLE PIKE RM 2S235
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

6608 GREYSWOOD RD
BETHESDA MD
20817-1537
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number0101059182
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: