Provider Demographics
NPI:1194778019
Name:MASCARENHAS, VILMA (MD)
Entity type:Individual
Prefix:
First Name:VILMA
Middle Name:
Last Name:MASCARENHAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6504 KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1386
Mailing Address - Country:US
Mailing Address - Phone:301-927-0088
Mailing Address - Fax:301-927-7239
Practice Address - Street 1:6502 KENILWORTH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1340
Practice Address - Country:US
Practice Address - Phone:301-927-0088
Practice Address - Fax:301-927-7239
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050932207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD905706R96Medicare ID - Type Unspecified
MDG51761Medicare UPIN