| Mary Ann Tesalona Md Corp | |
|
32845 Radio Rd Suite 101 Leesburg FL 34788-3977 | |
| (352) 315-1161 | |
| (352) 315-8438 |
| Full Name | Mary Ann Tesalona Md Corp |
|---|---|
| Speciality | Family Medicine |
| Location | 32845 Radio Rd, Leesburg, Florida |
| Authorized Official Name and Position | Mary Ann Dumayas Tesalona (M.D./OWNER) |
| Authorized Official Contact | 3523151161 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Ann Tesalona Md Corp 32845 Radio Rd Suite 101 Leesburg FL 34788-3977 Ph: (352) 315-1161 | Mary Ann Tesalona Md Corp 32845 Radio Rd Suite 101 Leesburg FL 34788-3977 Ph: (352) 315-1161 |
| NPI Number | 1952574923 |
|---|---|
| Provider Enumeration Date | 04/10/2008 |
| Last Update Date | 12/08/2011 |
| Medicare PECOS PAC ID | 8022283605 |
|---|---|
| Medicare Enrollment ID | O20111209000220 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952574923 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME0063400 (Florida) | Primary |
| Provider Name | Mary Ann Tesalona |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396744967 PECOS PAC ID: 5395822803 Enrollment ID: I20080408000826 |
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