Individual
DIANE M CERUZZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
500 MARKET STREET, SUITE 101, POCOMOKE, MD 21851-1170
(410) 957-6622
(410) 957-1229
Mailing address
10026 OLD OCEAN CITY BLVD, BUILDING ONE, BERLIN, MD 21811-1288
(410) 957-6622
(410) 957-1229
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
34007477
OH
207Q00000X
Family Medicine Physician
Primary
H70020
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
027366000
—
MD
05
—
1104803253
—
DE
01
—
173486YR5
MEDICARE UNSPECIFIED
MD
Enumeration date
12/29/2005
Last updated
03/14/2012
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