1477730109 NPI number — JOHN G. DELEONIBUS, D.P.M. PA

Table of content: (NPI 1477730109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477730109 NPI number — JOHN G. DELEONIBUS, D.P.M. PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN G. DELEONIBUS, D.P.M. PA
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:
6
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:
1477730109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2086 GENERALS HWY
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-6700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-266-7666
Provider Business Mailing Address Fax Number:
410-266-7703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2086 GENERALS HWY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-6700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-266-7666
Provider Business Practice Location Address Fax Number:
410-266-7703
Provider Enumeration Date:
01/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HARMELIN
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-266-7666

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  00899 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1394932 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 374588100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26825 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2700467 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T224JG . This is a "BSMD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5488 . This is a "BSDC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 455037 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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