Healthcare Provider Details

I. General information

NPI: 1730610304
Provider Name (Legal Business Name): MARY DI MASI CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3833 FAIRFAX DR STE 360
ARLINGTON VA
22203
US

IV. Provider business mailing address

8110 MAPLE LAWN BLVD STE 235
FULTON MD
20759-2694
US

V. Phone/Fax

Practice location:
  • Phone: 571-970-6050
  • Fax: 571-970-6352
Mailing address:
  • Phone: 301-340-8339
  • Fax: 301-340-9027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAC002025
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: