Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | D70582 | MD |
NPI | 1013031004 |
---|---|
Provider Name | Dr. Agostino J Visioni |
First Address | Annapolis, MD 21401-3046 |
Second Address | Annapolis, MD 21401-3263 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2007 |
Last Update Date | 07/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060-0003085 | VT PHYSICIAN'S LICENSE # (01) | VT |
311202100 | (05) | MD |
96458601 | BCBS (01) | MD |
96458602 | BCBS (01) | MD |
96458603 | BCBS (01) | MD |
96458604 | BCBS (01) | MD |
D3800007 | BCBS (01) | DC |
J4570009 | BCBS (01) | DC |
W8490001 | BCBS (01) | DC |