Provider Demographics
NPI:1407805856
Name:DEPIETRO, MICHAEL R (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:DEPIETRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4745 OGLETOWN STANTON RD
Mailing Address - Street 2:MAP 1, SUITE 220
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2067
Mailing Address - Country:US
Mailing Address - Phone:302-368-5515
Mailing Address - Fax:302-366-1240
Practice Address - Street 1:4745 OGLETOWN STANTON RD
Practice Address - Street 2:MAP 1, SUITE 220
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2067
Practice Address - Country:US
Practice Address - Phone:302-368-5515
Practice Address - Fax:302-366-1240
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DEC10005688207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0295282000OtherAMERIHEALTH/KEYSTONE
MD60959401OtherCARE FIRST BCBS
DE0000974301Medicaid
1255450004OtherCIGNA
550894OtherINDEPENDENCE BCBS
58079OtherCOVENTRY
289288OtherMAMSI
4397310OtherAETNA/USHC
1255450004OtherCIGNA
4397310OtherAETNA/USHC