Provider Demographics
NPI:1679510762
Name:SENATORE, JOHN R (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:SENATORE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:MONKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111-0374
Mailing Address - Country:US
Mailing Address - Phone:443-522-9749
Mailing Address - Fax:443-522-9725
Practice Address - Street 1:3333 N CALVERT ST
Practice Address - Street 2:SUITE 550
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-6514
Practice Address - Country:US
Practice Address - Phone:410-243-1313
Practice Address - Fax:410-243-1368
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00895213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCPIN 0001 GRP E152OtherBS-FEDERAL AND NCA
MD3159OtherELDER HEALTH
MD2700303OtherUNITED HEALTH CARE
MD2700303OtherUNITED HEALTH CARE
MD3159OtherELDER HEALTH