Healthcare Provider Details

I. General information

NPI: 1093176117
Provider Name (Legal Business Name): DIABETES SELF CARE MANAGEMENT INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 TOLEDO TER STE B103
HYATTSVILLE MD
20782-8146
US

IV. Provider business mailing address

3311 TOLEDO TER STE B103
HYATTSVILLE MD
20782-8146
US

V. Phone/Fax

Practice location:
  • Phone: 301-992-8243
  • Fax: 301-978-7986
Mailing address:
  • Phone: 301-992-8243
  • Fax: 301-978-7986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARJORIE R MADIKOTO
Title or Position: PRESIDENT AND CEO
Credential: C-FNP, CDE
Phone: 301-992-8243