Provider Demographics
NPI:1154329563
Name:VALLE, PIO G JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PIO
Middle Name:G
Last Name:VALLE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 DULANEY GATE CIR
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3013
Mailing Address - Country:US
Mailing Address - Phone:410-628-0525
Mailing Address - Fax:
Practice Address - Street 1:7845 OAKWOOD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4280
Practice Address - Country:US
Practice Address - Phone:410-761-8609
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0016226174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8726Medicare ID - Type Unspecified
MDD72178Medicare UPIN