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1104251685
MARIELLE DESTEFANO
BALTIMORE, MD
NPI
1104251685
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Former Name
MARIELLE GIBBONS
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
Enumeration Date
2013-09-04
Last Update Date
2019-05-09
Business Address
Miss MARIELLE DESTEFANO PA-C
4940 EASTERN AVE
BALTIMORE, MD 21224-2735
Phone number: 410-550-0100
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Mailing Address
Miss MARIELLE DESTEFANO PA-C
9910 FRANKLIN SQUARE DR STE 2110
BALTIMORE, MD 21236-4902
Phone number: 410-933-6423
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