Active NPI
Roberto Nestor Depetris, LAC
- Acupuncturist
- Bowie, MD
National Provider Identifier
1619312295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- U01746
- Practice address
- 14300 Gallant Fox LN
Bowie, MD 20715-4003 - Phone
- (301) 520-7017
- NPI assigned
- May 8, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | U01746 | MD | Primary |
Addresses
Primary practice location
14300 Gallant Fox LN
Bowie, MD 20715-4003
Mailing address
9501 Accord Dr
Potomac, MD 20854-4302
Phone (301) 520-7017
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| U01746 | MD | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1367971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367971200000",
"number": "1619312295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9501 ACCORD DR",
"city": "POTOMAC",
"state": "MD",
"postal_code": "208544302",
"telephone_number": "301-520-7017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14300 GALLANT FOX LN",
"city": "BOWIE",
"state": "MD",
"postal_code": "207154003",
"telephone_number": "301-520-7017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEPETRIS",
"first_name": "ROBERTO",
"middle_name": "NESTOR",
"name_prefix": "Mr.",
"credential": "LAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-05-08",
"last_updated": "2013-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "MD",
"license": "U01746",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bowie, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.