1649248071 NPI number — DR. JOHN P D'AMELIO DPM

Table of content: DR. JOHN P D'AMELIO DPM (NPI 1649248071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649248071 NPI number — DR. JOHN P D'AMELIO DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
D'AMELIO
Provider First Name:
JOHN
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
D'AMELIO
Provider Other First Name:
JOHN
Provider Other Middle Name:
P
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1649248071
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3720 HOLLAND RD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23452-2859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-498-0202
Provider Business Mailing Address Fax Number:
757-498-7936

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3720 HOLLAND RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23452-2859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-498-0202
Provider Business Practice Location Address Fax Number:
757-498-7936
Provider Enumeration Date:
03/10/2006

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: 213ES0103X , with the licence number:  0103000437 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5180770001 . This is a "DMERC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5180770002 . This is a "DMERC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9301518 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15803 . This is a "OPTIMA HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 216383 . This is a "MDIPA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 480021563 . This is a "RR MCR" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 005906 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com