Provider Demographics
NPI:1376760090
Name:SIMONETTI, DONALD WILLIAM JR (ACUPUNCTURIST, MAC)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:WILLIAM
Last Name:SIMONETTI
Suffix:JR
Gender:M
Credentials:ACUPUNCTURIST, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 ROCKS CHROME HILL RD
Mailing Address - Street 2:
Mailing Address - City:JARRETTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21084-1601
Mailing Address - Country:US
Mailing Address - Phone:443-966-4534
Mailing Address - Fax:
Practice Address - Street 1:3217 ROCKS CHROME HILL RD
Practice Address - Street 2:
Practice Address - City:JARRETTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21084-1601
Practice Address - Country:US
Practice Address - Phone:443-966-4534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2013-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01289171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist