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: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

PO BOX 64134
BALTIMORE MD
21264-4134
US

V. Phone/Fax

Practice location:
  • Phone: 667-214-2714
  • Fax:
Mailing address:
  • Phone: 667-214-2714
  • Fax: 410-448-6926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number29668
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberD0096291
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: