Healthcare Provider Details

I. General information

NPI: 1548666910
Provider Name (Legal Business Name): FREDRIC WILLIAM TINETTI DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15543 OLD COLUMBIA PIKE
BURTONSVILLE MD
20866-1633
US

IV. Provider business mailing address

15543 OLD COLUMBIA PIKE PO BOX 528
BURTONSVILLE MD
20866
US

V. Phone/Fax

Practice location:
  • Phone: 301-421-9200
  • Fax: 301-421-4106
Mailing address:
  • Phone: 301-421-9200
  • Fax: 301-421-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number1647
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: