Healthcare Provider Details

I. General information

NPI: 1275938201
Provider Name (Legal Business Name): MARJORIE RAY MADIKOTO C-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
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: 301-245-3082
  • Fax: 301-978-7986
Mailing address:
  • Phone: 301-245-3082
  • Fax: 301-260-2838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN60297
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR116887
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: