Healthcare Provider Details

I. General information

NPI: 1841296407
Provider Name (Legal Business Name): MARA J DAIDONE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HOSPITAL RD SUITE 304
PRINCE FREDERICK MD
20678-4019
US

IV. Provider business mailing address

100 HOSPITAL RD ATTN: AMY GRASSEY
PRINCE FREDERICK MD
20678-4017
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-4471
  • Fax:
Mailing address:
  • Phone: 410-414-4791
  • Fax: 410-414-4765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberD0055201
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: