Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | S01522 | MD |
NPI | 1356486450 |
---|---|
Provider Name | Dr. John Victor Demaio |
First Address | Gambrills, MD 21054-1651 |
Second Address | Gambrills, MD 21054-1651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U19303 | (02) | MD |