Healthcare Provider Details

I. General information

NPI: 1689872327
Provider Name (Legal Business Name): NOEL VETTICAD PESCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 11/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BLUERIDGE AVE
WHEATON MD
20902-4517
US

IV. Provider business mailing address

14138 FLINT ROCK RD
ROCKVILLE MD
20853-2653
US

V. Phone/Fax

Practice location:
  • Phone: 301-933-6440
  • Fax: 301-933-5923
Mailing address:
  • Phone: 301-460-1422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberD0067781
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: