Healthcare Provider Details

I. General information

NPI: 1558596411
Provider Name (Legal Business Name): MICAELA IANTORNO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 09/30/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NIH CRITICAL CARE MEDICINE 10 CENTER DR ROOM 2C145
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

PO BOX 3339
FREDERICKSBURG VA
22402-3339
US

V. Phone/Fax

Practice location:
  • Phone: 301-496-4336
  • Fax: 301-402-1213
Mailing address:
  • Phone: 855-739-9953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberD0074441
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101267135
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0074441
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101267135
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number0101267135
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: