Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 0103000977 | VA |
NPI | 1255343083 |
---|---|
Provider Name | John G Piacenti |
First Address | Chesapeake, VA 23320-8137 |
Second Address | Chesapeake, VA 23320-8137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U45932 | (02) | VA |