Provider Demographics
NPI:1437172277
Name:DELLAVECCHIA, MICHAEL ANTHONY (MD, PHD, FACS)
Entity Type:Individual
Prefix:PROF
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:DELLAVECCHIA
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Gender:M
Credentials:MD, PHD, FACS
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Mailing Address - Street 1:846 FARRAGUT RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-2005
Mailing Address - Country:US
Mailing Address - Phone:610-640-1578
Mailing Address - Fax:610-640-1578
Practice Address - Street 1:875 COUNTY LINE RD
Practice Address - Street 2:BRYN MAWR MED BLDG NORTH SUITE 204
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3143
Practice Address - Country:US
Practice Address - Phone:610-527-3406
Practice Address - Fax:610-527-3406
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2020-08-24
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Provider Licenses
StateLicense IDTaxonomies
PAMD020408E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PWDE145722Medicare ID - Type UnspecifiedMEDICARE
PAB39708Medicare UPIN