Healthcare Provider Details

I. General information

NPI: 1144647454
Provider Name (Legal Business Name): VINCENZO GIANNELLI MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 M ST NW STE 313
WASHINGTON DC
20037-1449
US

IV. Provider business mailing address

2440 M ST NW STE 313
WASHINGTON DC
20037-1449
US

V. Phone/Fax

Practice location:
  • Phone: 202-775-1792
  • Fax: 202-775-0494
Mailing address:
  • Phone: 202-775-1792
  • Fax: 202-775-0494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD20747
License Number StateDC

VIII. Authorized Official

Name: DR. VINCENZO GIANNELLI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 202-775-1792