Provider Demographics
NPI:1467646380
Name:DISCEPOLO-CHIANCONE, ANTONIETTA (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIETTA
Middle Name:
Last Name:DISCEPOLO-CHIANCONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4061 POWDER MILL RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CALVERTON
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3149
Mailing Address - Country:US
Mailing Address - Phone:202-669-8501
Mailing Address - Fax:240-846-1490
Practice Address - Street 1:25500 POINT LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2015
Practice Address - Country:US
Practice Address - Phone:301-475-6106
Practice Address - Fax:301-475-6431
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0075614207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine