Provider Demographics
NPI:1255148029
Name:DIDONATO, NICHOLAS JOSEPH
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:JOSEPH
Last Name:DIDONATO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 ARMY PENTAGON CORRIDOR 8 ROOM MG878A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20310-0001
Mailing Address - Country:US
Mailing Address - Phone:703-692-6220
Mailing Address - Fax:
Practice Address - Street 1:5801 ARMY PENTAGON CORRIDOR 8 ROOM MG878A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20310-0001
Practice Address - Country:US
Practice Address - Phone:703-692-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2675840246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist