Provider Demographics
NPI:1588844849
Name:LATTANZIO, MICHAEL RAYMOND (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAYMOND
Last Name:LATTANZIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 N 13TH ST APT B27
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-7533
Mailing Address - Country:US
Mailing Address - Phone:610-505-6313
Mailing Address - Fax:
Practice Address - Street 1:1307 N 13TH ST APT B27
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-7533
Practice Address - Country:US
Practice Address - Phone:610-505-6313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT011368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine