MEDICARE: MS. MARY ELIZABETH D'AMATO LMT

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	171W00000X	Contractor	M04152	MD

General Provider Information

NPI Number	:	1134442437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ELIZABETH D'AMATO LMT

Provider Business Mailing Address
First Line	:	14121 BAUER DR
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20853-2120
Country	:	US
Telephone Number	:	240-418-8454
Fax Number	:

Provider Business Practice Location Address
First Line	:	3905 NATIONAL DR
Second Line	:	SUITE 375
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-1100
Country	:	US
Telephone Number	:	301-476-7575
Fax Number	:

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

Provider Enumeration Date	:	03/01/2010
Last Update Date	:	03/01/2010

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