Healthcare Provider Details

I. General information

NPI: 1124020144
Provider Name (Legal Business Name): PETER JOHN GIANNONE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE STREET MN 470
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

800 ROSE STREET MN 470
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-1496
  • Fax: 859-323-1496
Mailing address:
  • Phone: 859-323-1496
  • Fax: 859-257-6066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number46822
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: