Provider Demographics
NPI:1669203378
Name:DIPIETRO, NICHOLAS BRAEDON (HAD #02830 MD)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:BRAEDON
Last Name:DIPIETRO
Suffix:
Gender:M
Credentials:HAD #02830 MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8837 BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2403
Mailing Address - Country:US
Mailing Address - Phone:410-931-2688
Mailing Address - Fax:
Practice Address - Street 1:8837 BELAIR RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-2403
Practice Address - Country:US
Practice Address - Phone:410-931-2688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02830237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist