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General NPI Number Information
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NPI Number | 1689244451
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Entity Type | Individual
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Provider Name | MATTEO MAISANO PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/25/2021
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Last Update Date | 03/21/2022
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Provider Practice Location Address
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Address Line | 3489 SEMINOLE TRL
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-5637
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Country | US
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Telephone | 434-964-1082
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Fax |
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Provider Business Mailing Address
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Address Line | 2628 SNOWMASS DR
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City | ROCKINGHAM
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State | VA
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Zip | 22801-3671
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Country | US
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Telephone | 540-412-3479
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0202219576
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License Number State | VA
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