Provider Demographics
NPI:1326006636
Name:FANELLI, ALLISON S (DO)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:S
Last Name:FANELLI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:SAGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19723-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-4000
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:789 E. LANCASTER AVE.
Practice Address - Street 2:SUITE 10
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-1522
Practice Address - Country:US
Practice Address - Phone:484-381-4010
Practice Address - Fax:484-381-4020
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2017-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07748900208000000X
PAOS013287208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102999050Medicaid