Provider Demographics
NPI:1477521847
Name:VALVANO, THOMAS JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:VALVANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 SW GAINES STREET, MAIL CODE:CDRCP
Mailing Address - Street 2:DOERNBECHER CHILDREN'S HOSPITAL, GENERAL PEDIATRICS
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2998
Mailing Address - Country:US
Mailing Address - Phone:503-494-6513
Mailing Address - Fax:503-418-5780
Practice Address - Street 1:707 SW GAINES STREET
Practice Address - Street 2:DOERNBECHER CHILDREN'S HOSPITAL
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2998
Practice Address - Country:US
Practice Address - Phone:503-494-6513
Practice Address - Fax:503-418-5780
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107015208000000X
ORMD126268208000000X
WI49380-020208000000X
IL036-107015208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107015Medicaid
I36718Medicare UPIN
IL036107015Medicaid