Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1897 | ME |
NPI | 1508065210 |
---|---|
Provider Name | Dr. Joshua Iannetta |
First Address | Scarborough, ME 04074-9794 |
Second Address | Scarborough, ME 04074-9794 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 04/01/2012 |