| Doctor Name: | JEROME DEPETRIS |
| NPI Number: | 1003222704 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | R2580 |
| Business Practice Address: | 8601 Lasalle Rd 100 Towson, MD - 212862005 |
| Business Phone Number: | 4103378910 |
| Business Fax Number: | 4103378327 |
| Mailing Address: | 8601 Lasalle Road, Suite 100 TOWSON |
| State: | MD |
| Postal Code: | 212862005 |
| Phone Number: | 4103378910 |
| Fax Number: | 4103378327 |
| NPI Enumeration Date: | 07/02/2014 |
| NPI Last Update Date: | 07/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251E00000X |
| License Number: | R2580 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Home Health |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety. |