Provider Demographics
NPI:1114936895
Name:PIACENTINO, JOHN DOMINIC (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOMINIC
Last Name:PIACENTINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470-L PROSPECT BLVD
Mailing Address - Street 2:CORP-OHS
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6400
Mailing Address - Country:US
Mailing Address - Phone:240-566-3001
Mailing Address - Fax:
Practice Address - Street 1:470 PROSPECT BLVD # L
Practice Address - Street 2:CORP-OHS
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-6400
Practice Address - Country:US
Practice Address - Phone:240-566-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055809207R00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine