MEDICARE: DR. MARLENE GABRIEL DESAMITO M.D.

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	208000000X	Pediatrics Physician	D0053700	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7221153	OTHER	MD	AETNA PROV. NO.
2	1203744	OTHER	MD	UHC/AMERICHOICE PROV. NO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	94909	OTHER	MD	AMERIGROUP PROV. NO.

General Provider Information

NPI Number	:	1760566996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARLENE GABRIEL DESAMITO M.D.

Provider Business Mailing Address
First Line	:	3311 TOLEDO TER
Second Line	:	SUITE C105
City	:	HYATTSVILLE
State	:	MD
Zip	:	20782-4135
Country	:	US
Telephone Number	:	301-559-3323
Fax Number	:	301-599-3325

Provider Business Practice Location Address
First Line	:	3311 TOLEDO TER
Second Line	:	SUITE C105
City	:	HYATTSVILLE
State	:	MD
Zip	:	20782-4135
Country	:	US
Telephone Number	:	301-559-3323
Fax Number	:	301-599-3325

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	06/20/2009

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Directions to “ DR. MARLENE GABRIEL DESAMITO M.D.” Practice Location

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