Provider Demographics
NPI:1578909602
Name:VALLETTA, ROBERT A (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:VALLETTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 LOGANS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-9216
Mailing Address - Country:US
Mailing Address - Phone:724-335-9114
Mailing Address - Fax:724-335-9114
Practice Address - Street 1:2026 LOGANS FERRY RD
Practice Address - Street 2:
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-9216
Practice Address - Country:US
Practice Address - Phone:724-335-9114
Practice Address - Fax:724-335-9114
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004541L111N00000X
PARP037807R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU13018Medicare UPIN