Healthcare Provider Details

I. General information

NPI: 1992709752
Provider Name (Legal Business Name): MARIA E. COLUCCIELLO D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 RIDGELY AVE STE 20
ANNAPOLIS MD
21401-1409
US

IV. Provider business mailing address

101 RIDGELY AVE
ANNAPOLIS MD
21401-1409
US

V. Phone/Fax

Practice location:
  • Phone: 410-263-3709
  • Fax:
Mailing address:
  • Phone: 410-263-3709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7920
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: