Provider Demographics
NPI:1932389525
Name:DEPETRILLO, PAOLO B (MD)
Entity Type:Individual
Prefix:DR
First Name:PAOLO
Middle Name:B
Last Name:DEPETRILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5204 SANGAMORE RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-2322
Mailing Address - Country:US
Mailing Address - Phone:301-320-8648
Mailing Address - Fax:301-320-0529
Practice Address - Street 1:5204 SANGAMORE RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816-2322
Practice Address - Country:US
Practice Address - Phone:301-320-8648
Practice Address - Fax:301-320-0529
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54557207R00000X, 208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine