1093176117 NPI number — DIABETES SELF CARE MANAGEMENT INSTITUTE, LLC

Table of content: MR. MICHAEL JOHN GELLERT M.A., M.S.W. (NPI 1578702155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093176117 NPI number — DIABETES SELF CARE MANAGEMENT INSTITUTE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIABETES SELF CARE MANAGEMENT INSTITUTE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093176117
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3311 TOLEDO TER STE B103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HYATTSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20782-8146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-992-8243
Provider Business Mailing Address Fax Number:
301-978-7986

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3311 TOLEDO TER STE B103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HYATTSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20782-8146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-992-8243
Provider Business Practice Location Address Fax Number:
301-978-7986
Provider Enumeration Date:
03/17/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MADIKOTO
Authorized Official First Name:
MARJORIE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
301-992-8243

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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