Active NPI
Marlene Gabriel Desamito, M.D.
- Pediatrics Physician
- Hyattsville, MD
National Provider Identifier
1760566996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- D0053700
- Practice address
- 3311 Toledo Ter
Suite C105
Hyattsville, MD 20782-4135 - Phone
- (301) 559-3323
- Fax
- (301) 599-3325
- NPI assigned
- Oct 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | D0053700 | MD | Primary |
Addresses
Primary practice location
3311 Toledo Ter
Suite C105
Hyattsville, MD 20782-4135
Mailing address
3311 Toledo Ter
Suite C105
Hyattsville, MD 20782-4135
Phone (301) 559-3323
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7221153 | Other | MD | AETNA PROV. NO. |
| 1203744 | Other | MD | UHC/AMERICHOICE PROV. NO |
| 1356020 00 | Medicaid | MD | |
| 94909 | Other | MD | AMERIGROUP PROV. NO. |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0053700 | MD | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marlene G Desamito M D L L C | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Primary Care Clinic/Center
- Hyattsville, MD
- NPI 1356516470
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245456000000",
"number": "1760566996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3311 TOLEDO TER",
"address_2": "SUITE C105",
"city": "HYATTSVILLE",
"state": "MD",
"postal_code": "207824135",
"telephone_number": "301-559-3323",
"fax_number": "301-599-3325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3311 TOLEDO TER",
"address_2": "SUITE C105",
"city": "HYATTSVILLE",
"state": "MD",
"postal_code": "207824135",
"telephone_number": "301-559-3323",
"fax_number": "301-599-3325"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESAMITO",
"first_name": "MARLENE",
"middle_name": "GABRIEL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-24",
"last_updated": "2009-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MD",
"license": "D0053700",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PROV. NO.",
"identifier": "7221153",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC/AMERICHOICE PROV. NO",
"identifier": "1203744",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1356020 00",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP PROV. NO.",
"identifier": "94909",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hyattsville, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.