Provider Demographics
NPI:1821001801
Name:GIARDINA, VITO NICHOLAS (DPM)
Entity type:Individual
Prefix:
First Name:VITO
Middle Name:NICHOLAS
Last Name:GIARDINA
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 1:4660 WILKENS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-4848
Mailing Address - Country:US
Mailing Address - Phone:410-242-7066
Mailing Address - Fax:410-242-4126
Practice Address - Street 1:4660 WILKENS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4848
Practice Address - Country:US
Practice Address - Phone:410-242-7066
Practice Address - Fax:410-242-4126
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00440213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD602448300Medicaid
MDK925GI32082007OtherBLUE SHIELD
MDS12832082006OtherBLUE SHIELD
DC30650001OtherBLUE SHIELD DC
DC30650001OtherBLUE SHIELD DC
T59777Medicare UPIN
MD0470210004Medicare NSC
MDS12832082006OtherBLUE SHIELD
MD0470210002Medicare NSC