1699756999 NPI number — DR. ITALO MARCELLO BASTIANELLI D.O.

Table of content: DR. ITALO MARCELLO BASTIANELLI D.O. (NPI 1699756999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699756999 NPI number — DR. ITALO MARCELLO BASTIANELLI D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASTIANELLI
Provider First Name:
ITALO
Provider Middle Name:
MARCELLO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1699756999
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6455 MACHINE ST BLDG 2501
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABERDEEN PROVING GROUND
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21005-5213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KIRK US ARMY HEALTH CLINIC
Provider Second Line Business Practice Location Address:
6455 MACHINE STREET
Provider Business Practice Location Address City Name:
ABERDEEN PROVING GROUND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-278-1763
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X , with the licence number:  25MB05892100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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