Healthcare Provider Details

I. General information

NPI: 1093639221
Provider Name (Legal Business Name): LUCA GIANNI NICOLA PEDONE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 OLD MAIN
UNIVERSITY PARK PA
16802-1503
US

IV. Provider business mailing address

6903 OLSON RD
TAKOMA PARK MD
20912-6501
US

V. Phone/Fax

Practice location:
  • Phone: 240-702-3866
  • Fax:
Mailing address:
  • Phone: 240-702-3866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: