Provider Demographics
NPI:1366475089
Name:TARANTINO, PAUL ANGELO (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANGELO
Last Name:TARANTINO
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 1:806 LANDMARK DRIVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4980
Mailing Address - Country:US
Mailing Address - Phone:410-590-9260
Mailing Address - Fax:410-590-9266
Practice Address - Street 1:806 LANDMARK DR
Practice Address - Street 2:SUITE 114
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4980
Practice Address - Country:US
Practice Address - Phone:410-590-9260
Practice Address - Fax:410-590-9266
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD43467174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF10665Medicare UPIN