Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | S02085 | MD |
NPI | 1629123666 |
---|---|
Provider Name | Dr. Louis S. Crivelli II |
First Address | Crofton, MD 21114-1154 |
Second Address | Greenbelt, MD 20770-2481 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U92254 | (02) | MD |