Provider Demographics
NPI:1255343083
Name:PIACENTI, JOHN G (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:PIACENTI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1416 SHENANDOAH PKWY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-8137
Mailing Address - Country:US
Mailing Address - Phone:757-549-7945
Mailing Address - Fax:757-549-2004
Practice Address - Street 1:1416 SHENANDOAH PKWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-8137
Practice Address - Country:US
Practice Address - Phone:757-549-7945
Practice Address - Fax:757-549-2004
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000977213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU45932Medicare UPIN
VA00W457JO1Medicare ID - Type UnspecifiedPODIATRIST