MEDICARE: JUSTINA DEBELLA MAMMERI C.N.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	R156307	MD

General Provider Information

NPI Number	:	1134114101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINA DEBELLA MAMMERI C.N.M.

Provider Business Mailing Address
First Line	:	301 SAINT PAUL PL
Second Line	:	P.O.B. 501
City	:	BALTIMORE
State	:	MD
Zip	:	21202-2102
Country	:	US
Telephone Number	:	410-347-5700
Fax Number	:	410-347-5744

Provider Business Practice Location Address
First Line	:	1838 GREENE TREE RD
Second Line	:	SUITE 380
City	:	PIKESVILLE
State	:	MD
Zip	:	21208-6391
Country	:	US
Telephone Number	:	410-415-5577
Fax Number	:	410-415-6682

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	06/16/2010

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