Individual
DR. ITALO MARCELLO BASTIANELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
FORT GEORGE G. MEADE MEDDAC, 2480 LLEWELLYN AVE/SUITE 5800, FORT MEADE, MD 20755-5129
(410) 278-1763
Mailing address
6455 MACHINE ST BLDG 2501, ABERDEEN PROVING GROUND, MD 21005-5213
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
25MB05892100
NJ
207VX0000X
Obstetrics Physician
Primary
25MB05892100
NJ
Other
Enumeration date
11/14/2005
Last updated
02/19/2025
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