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General NPI Number Information
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NPI Number | 1952574923
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Entity Type | Organization
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Legal Business Name | MARY ANN TESALONA MD CORP
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 32845 RADIO RD SUITE 101
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City | LEESBURG
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State | FL
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Zip | 34788-3977
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Country | US
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Telephone | 352-315-1161
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Fax | 352-315-8438
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Provider Business Mailing Address
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Address Line | 32845 RADIO RD SUITE 101
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City | LEESBURG
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State | FL
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Zip | 34788-3977
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Country | US
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Telephone | 352-315-1161
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Fax | 352-315-8438
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Authorized Official
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Title or Position | M.D./OWNER
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Name | DR. MARY ANN DUMAYAS TESALONA
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Credential | M.D.
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Telephone | 352-315-1161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0063400
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License Number State | FL
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