Provider Demographics
NPI:1285721787
Name:JOHN P. VISIOLI,D.O, P.A.
Entity type:Organization
Organization Name:JOHN P. VISIOLI,D.O, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:VISIOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:410-352-5527
Mailing Address - Street 1:PO BOX 196
Mailing Address - Street 2:
Mailing Address - City:BISHOPVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21813-0196
Mailing Address - Country:US
Mailing Address - Phone:410-352-5527
Mailing Address - Fax:410-352-3024
Practice Address - Street 1:100 E CARROLL ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5422
Practice Address - Country:US
Practice Address - Phone:410-352-5527
Practice Address - Fax:410-352-3024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0059368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH49339Medicare UPIN
MD778MMedicare ID - Type UnspecifiedMEDICARE GROUP#