Healthcare Provider Details

I. General information

NPI: 1962683797
Provider Name (Legal Business Name): DIVILIO & DINAPOLI PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 MARVEL CT.
EASTON MD
21601-4052
US

IV. Provider business mailing address

404 MARVEL CT.
EASTON MD
21601-4052
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-4281
  • Fax:
Mailing address:
  • Phone: 410-822-4281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD38990
License Number StateMD

VIII. Authorized Official

Name: CHARLES E DINAPOLI
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 410-822-4281