Provider Demographics
NPI:1801969753
Name:DAMIANO, MICHAEL JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:DAMIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 HANOVER PARKWAY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2009
Mailing Address - Country:US
Mailing Address - Phone:301-441-8711
Mailing Address - Fax:301-441-4859
Practice Address - Street 1:7500 HANOVER PARKWAY
Practice Address - Street 2:SUITE 207
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2009
Practice Address - Country:US
Practice Address - Phone:301-441-8711
Practice Address - Fax:301-441-4859
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0039146207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD752761600Medicaid
714741D81Medicare ID - Type Unspecified
MD752761600Medicaid