Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Miss. Marielle Destefano, PA-C

Individual provider Physician Assistant · NPI 1104251685

Miss. Marielle Destefano, PA-C is a Physician Assistant in Baltimore, Maryland. Qualified in 2013, 13 years ago. Practices with Agape Physical Therapy and Sports Rehabilitation LP, a 677-clinician group and accepts Medicare assignment. Licensed in Maryland.

Years since qualifying
13
Licensed in
MD
In the registry since
2013
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

4940 Eastern Ave
Baltimore, MD 21224-2735
Phone: (410) 550-0100
Fax: (410) 550-2899
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X (MD)

Record details

NPI number1104251685
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 4, 2013
Last updated in NPPESMay 9, 2019

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Agape Physical Therapy And Sports Rehabilitation Lp — 677 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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