Healthcare Provider Details

I. General information

NPI: 1649248071
Provider Name (Legal Business Name): JOHN P D'AMELIO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN P D'AMELIO DPM

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 HOLLAND RD STE 100
VIRGINIA BEACH VA
23452-2859
US

IV. Provider business mailing address

3720 HOLLAND RD STE 100
VIRGINIA BEACH VA
23452-2859
US

V. Phone/Fax

Practice location:
  • Phone: 757-498-0202
  • Fax: 757-498-7936
Mailing address:
  • Phone: 757-498-0202
  • Fax: 757-498-7936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103000437
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: