Individual
MS. MARY DIFONZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MARY DIFONZO PA-C
Contact information
Practice address
30 CHATEAU DR SE, ROME, GA 30161-7201
(706) 291-3753
Mailing address
902 HILTON AVE, BALTIMORE, MD 21228-5874
(410) 747-8382
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C00001729
MD
Other
Enumeration date
08/17/2010
Last updated
08/17/2010
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