Provider Demographics
NPI:1043086648
Name:JABOSUNG, MARILYNE T
Entity type:Individual
Prefix:
First Name:MARILYNE
Middle Name:T
Last Name:JABOSUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6303 CHESWOLD PL
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2829
Mailing Address - Country:US
Mailing Address - Phone:240-726-2267
Mailing Address - Fax:
Practice Address - Street 1:1615 RHODE ISLAND AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1802
Practice Address - Country:US
Practice Address - Phone:240-726-2267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator