Basic Information
| Provider Information | |||||||||
| NPI: | 1578793212 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'DONNELL DEBRITZ | ||||||||
| FirstName: | MAUREEN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| OtherLastName: | O'DONNELL | ||||||||
| OtherFirstName: | MAUREEN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9910 FRANKLIN SQUARE DR STE 2110 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212364902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109336423 | ||||||||
| FaxNumber: | 4109331390 | ||||||||
| Practice Location | |||||||||
| Address1: | 3620 JOSEPH SIEWICK DR. | ||||||||
| Address2: | SUITE 406 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033598640 | ||||||||
| FaxNumber: | 7035916105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2009 | ||||||||
| LastUpdateDate: | 06/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | D82233 | MD | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 0101059017 | VA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD041998 | DC | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.