Provider Demographics
NPI:1366537102
Name:DELEONIBUS, JOHN G (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:DELEONIBUS
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 1:2086 GENERALS HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-6700
Mailing Address - Country:US
Mailing Address - Phone:410-266-7666
Mailing Address - Fax:410-266-7703
Practice Address - Street 1:2086 GENERALS HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-6700
Practice Address - Country:US
Practice Address - Phone:410-266-7666
Practice Address - Fax:410-266-7703
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00899213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2700467OtherUNITED HEALTHCARE PROVIDE
MD455037OtherAETNA PROVIDER ID
MD41259901OtherBCBS-MD
MD1394932OtherCIGNA PROVIDER ID
MD336315501Medicaid
MD002778200Medicaid
MD336315500Medicaid
MD336315502Medicaid
521709568OtherTAX ID
DC54880001OtherBCBS DC
MD26825OtherMAMSI PROVIDER ID
MD0750330001Medicare NSC
DC54880001OtherBCBS DC
MDT59871Medicare UPIN
MD336315502Medicaid