Provider Demographics
NPI:1306943212
Name:DELLA PENNA, NICCOLO DENO (MD)
Entity type:Individual
Prefix:
First Name:NICCOLO
Middle Name:DENO
Last Name:DELLA PENNA
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 1:2324 W JOPPA RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4615
Mailing Address - Country:US
Mailing Address - Phone:410-583-2623
Mailing Address - Fax:410-583-2949
Practice Address - Street 1:2324 W JOPPA RD
Practice Address - Street 2:SUITE 220
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4615
Practice Address - Country:US
Practice Address - Phone:410-583-2623
Practice Address - Fax:410-583-2949
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4289062084P0800X
MDD00644252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry