Healthcare Provider Details

I. General information

NPI: 1467639161
Provider Name (Legal Business Name): JOHN R SENATORE DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 N CALVERT ST SUITE 550
BALTIMORE MD
21218-6514
US

IV. Provider business mailing address

PO BOX 374
MONKTON MD
21111-0374
US

V. Phone/Fax

Practice location:
  • Phone: 410-243-1313
  • Fax:
Mailing address:
  • Phone: 443-522-9749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00895
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number00895
License Number StateMD

VIII. Authorized Official

Name: PAM JANNEY
Title or Position: BILLING MANAGER
Credential:
Phone: 443-522-9749