Provider Demographics
NPI:1457481467
Name:DUILIO VALDIVIA MD PC
Entity Type:Organization
Organization Name:DUILIO VALDIVIA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUILIO
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDIVIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-242-2594
Mailing Address - Street 1:27 SANDY LN
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1310
Mailing Address - Country:US
Mailing Address - Phone:717-242-2594
Mailing Address - Fax:717-242-0582
Practice Address - Street 1:27 SANDY LN
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1310
Practice Address - Country:US
Practice Address - Phone:717-242-2594
Practice Address - Fax:717-242-0582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022186E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA13837OtherGEISINGER PCP
PA0400572OtherRAILROAD MEDICARE
PA000928225Medicaid
PA03076400OtherPCP CBC
PAW105OtherPCP GEISINGER
PA03076400OtherPCP CBC