Provider Demographics
NPI:1235197948
Name:IMPEDUGLIA, GIOVANNI (MD)
Entity Type:Individual
Prefix:
First Name:GIOVANNI
Middle Name:
Last Name:IMPEDUGLIA
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 1:11161 NEW HAMPSHIRE AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904
Mailing Address - Country:US
Mailing Address - Phone:301-681-7101
Mailing Address - Fax:301-681-8127
Practice Address - Street 1:11161 NEW HAMPSHIRE AVE
Practice Address - Street 2:STE 301
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904
Practice Address - Country:US
Practice Address - Phone:301-681-7101
Practice Address - Fax:301-681-8127
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0036322208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics