Provider Demographics
NPI:1205846102
Name:AVALLONE, JOHN MICHAEL
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:AVALLONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2306
Mailing Address - Country:US
Mailing Address - Phone:410-757-2778
Mailing Address - Fax:410-757-0632
Practice Address - Street 1:83 CHURCH RD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2306
Practice Address - Country:US
Practice Address - Phone:410-757-2778
Practice Address - Fax:410-757-0632
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD36805207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406116100Medicaid
7869439OtherAETNA PPO
1554500OtherAETNA HMO
0001OtherBCBS
61759202OtherBCBS