MEDICARE: DR. MARJORIE FRICKE DEBENEDICTIS MD

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	207W00000X	Ophthalmology Physician	M001334	GU

General Provider Information

NPI Number	:	1659458248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARJORIE FRICKE DEBENEDICTIS MD

Provider Business Mailing Address
First Line	:	633 GOV CARLOS CAMACHO RD.
Second Line	:	SUITE 103
City	:	TAMUNING
State	:	GU
Zip	:	96913-3300
Country	:	US
Telephone Number	:	671-647-5829
Fax Number	:	671-647-5830

Provider Business Practice Location Address
First Line	:	633 GOV CARLOS CAMACHO RD.
Second Line	:	SUITE 103
City	:	TAMUNING
State	:	GU
Zip	:	96913-3300
Country	:	US
Telephone Number	:	671-647-5829
Fax Number	:	671-647-5830

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	06/12/2013

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