Provider Demographics
NPI:1558393611
Name:ALTADONNA, VICTOR F (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:F
Last Name:ALTADONNA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2106 HARRISBURG PIKE
Mailing Address - Street 2:STE 200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-3200
Mailing Address - Country:US
Mailing Address - Phone:717-393-1771
Mailing Address - Fax:717-393-2782
Practice Address - Street 1:2106 HARRISBURG PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-393-1771
Practice Address - Fax:717-393-2782
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-12-21
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Provider Licenses
StateLicense IDTaxonomies
PAMD030755E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011416670002Medicaid
E23168Medicare UPIN
562110EMQMedicare PIN