Italo Marcello Bastianelli, D.O.

Primary specialty

Obstetrics PhysicianTaxonomy code 207VX0000X

License

25MB05892100 Issued in NJ

Practice address

Fort George G. Meade Meddac
2480 Llewellyn Ave/Suite 5800
Fort Meade, MD 20755-5129

Phone

(410) 278-1763

NPI assigned

Nov 14, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1699756999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6455 MACHINE ST BLDG 2501",
            "city": "ABERDEEN PROVING GROUND",
            "state": "MD",
            "postal_code": "210055213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "FORT GEORGE G. MEADE MEDDAC",
            "address_2": "2480 LLEWELLYN AVE/SUITE 5800",
            "city": "FORT MEADE",
            "state": "MD",
            "postal_code": "207555129",
            "telephone_number": "410-278-1763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASTIANELLI",
        "first_name": "ITALO",
        "middle_name": "MARCELLO",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-14",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "NJ",
            "license": "25MB05892100",
            "primary": true
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "NJ",
            "license": "25MB05892100",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Anderson, DMD
• Liam Magaly Aponte, NP-C
• Richard Wilfred Arthur, APRN
• Baltimore Vamc
• Shawndra Bass, RDH, BS
• Manjula Basu, M.D.
• Audreial Beard
• Aaron Bennett
• Takelya Benson, DNP, FNP-C
• Barbara Kumea Berkoh

• Obstetrics Physician in Fort Meade, MD
• Providers in Fort Meade, MD by specialty
• Obstetrics Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.