Healthcare Provider Details

I. General information

NPI: 1942694914
Provider Name (Legal Business Name): LOUIS BIVONA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 MCHENRY RD STE 1200
ABERDEEN MD
21001-2856
US

IV. Provider business mailing address

PO BOX 64134
BALTIMORE MD
21264-4134
US

V. Phone/Fax

Practice location:
  • Phone: 410-448-6400
  • Fax: 443-843-5522
Mailing address:
  • Phone: 667-214-2714
  • Fax: 410-448-6926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number29668
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: