Healthcare Provider Details

I. General information

NPI: 1134114101
Provider Name (Legal Business Name): JUSTINA DEBELLA MAMMERI C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1838 GREENE TREE RD SUITE 380
PIKESVILLE MD
21208-6391
US

IV. Provider business mailing address

301 SAINT PAUL PL P.O.B. 501
BALTIMORE MD
21202-2102
US

V. Phone/Fax

Practice location:
  • Phone: 410-415-5577
  • Fax: 410-415-6682
Mailing address:
  • Phone: 410-347-5700
  • Fax: 410-347-5744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberR156307
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: