MEDICARE: DR. DEBORAH LYNN DALLAM 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	2084P0805X	Geriatric Psychiatry Physician	DOO29727	MD

General Provider Information

NPI Number	:	1891896106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH LYNN DALLAM M.D.

Provider Business Mailing Address
First Line	:	11507 RABBIT RUN TER
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-4212
Country	:	US
Telephone Number	:	301-622-2399
Fax Number	:	301-622-2399

Provider Business Practice Location Address
First Line	:	13415 CONNECTICUT AVE
Second Line	:	SUITE 105
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-2910
Country	:	US
Telephone Number	:	202-806-7797
Fax Number	:

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/08/2007

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