Provider Demographics
NPI:1407864309
Name:ANTONIO B VALENTIN MD PA
Entity Type:Organization
Organization Name:ANTONIO B VALENTIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:B
Authorized Official - Last Name:VALENTIN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:301-474-8998
Mailing Address - Street 1:7313 HANOVER PKWY
Mailing Address - Street 2:#A
Mailing Address - City:GREENBELT
Mailing Address - State:MA
Mailing Address - Zip Code:20770
Mailing Address - Country:US
Mailing Address - Phone:301-474-8998
Mailing Address - Fax:301-474-8999
Practice Address - Street 1:7313 HANOVER PKWY
Practice Address - Street 2:#A
Practice Address - City:GREENBELT
Practice Address - State:MA
Practice Address - Zip Code:20770
Practice Address - Country:US
Practice Address - Phone:301-474-8998
Practice Address - Fax:301-474-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0014252208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
410112Medicare ID - Type Unspecified
B94675Medicare UPIN