1083746671 NPI number — DR. PAOLO MARCIANO AGOSTINELLI MD PHD

Table of content: PAMELA GUILBAULT (NPI 1427880152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083746671 NPI number — DR. PAOLO MARCIANO AGOSTINELLI MD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARCIANO AGOSTINELLI
Provider First Name:
PAOLO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD PHD
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:
1083746671
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
INTERVENTIONAL RADIOLOGY
Provider Second Line Business Mailing Address:
3601 W 13 MILE RD
Provider Business Mailing Address City Name:
ROYAL OAK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48073-6712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-898-7456
Provider Business Mailing Address Fax Number:
248-898-4316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
INTERVENTIONAL RADIOLOGY
Provider Second Line Business Practice Location Address:
3601 W 13 MILE RD
Provider Business Practice Location Address City Name:
ROYAL OAK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48073-6712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-898-7456
Provider Business Practice Location Address Fax Number:
248-898-4316
Provider Enumeration Date:
03/10/2007

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: 2085R0202X , with the licence number:  2004012738 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 4301094023 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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