Healthcare Provider Details

I. General information

NPI: 1205881182
Provider Name (Legal Business Name): VINCENZO GIANNELLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
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

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 202-775-1792
  • Fax: 202-775-0494
Mailing address:
  • Phone: 920-663-9035
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: