Healthcare Provider Details

I. General information

NPI: 1063766913
Provider Name (Legal Business Name): MR. JOSEPH SACCO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 01/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7103 DEMOCRACY BLVD SEARS MIRACLE EAR MONTGOMERY MALL
BETHESDA MD
20817
US

IV. Provider business mailing address

7103 DEMOCRACY BLVD SEARS MIRACLE EAR MONTGOMERY MALL
BETHESDA MD
20817
US

V. Phone/Fax

Practice location:
  • Phone: 301-365-6270
  • Fax:
Mailing address:
  • Phone: 301-365-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2701
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: