MEDICARE: DR. MARA J DAIDONE 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	207Y00000X	Otolaryngology Physician	D0055201	MD

General Provider Information

NPI Number	:	1841296407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARA J DAIDONE M.D.

Provider Business Mailing Address
First Line	:	100 HOSPITAL RD
Second Line	:	ATTN: AMY GRASSEY
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-4017
Country	:	US
Telephone Number	:	410-414-4791
Fax Number	:	410-414-4765

Provider Business Practice Location Address
First Line	:	110 HOSPITAL RD
Second Line	:	SUITE 304
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-4019
Country	:	US
Telephone Number	:	410-535-4471
Fax Number	:

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/09/2007

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