MEDICARE: LOUIS BIVONA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0117X	Orthopaedic Surgery of the Spine Physician	29668	WV
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1942694914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUIS BIVONA

Provider Business Mailing Address
First Line	:	PO BOX 64134
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-4134
Country	:	US
Telephone Number	:	667-214-2714
Fax Number	:	410-448-6926

Provider Business Practice Location Address
First Line	:	650 MCHENRY RD STE 1200
Second Line	:
City	:	ABERDEEN
State	:	MD
Zip	:	21001-2856
Country	:	US
Telephone Number	:	410-448-6400
Fax Number	:	443-843-5522

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	07/11/2025

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Directions to “ LOUIS BIVONA ” Practice Location

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