Provider Demographics
NPI:1659375699
Name:AVALLONE, VINCENT RICHARD JR (DO)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:RICHARD
Last Name:AVALLONE
Suffix:JR
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 1:801 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7033
Mailing Address - Country:US
Mailing Address - Phone:717-270-6900
Mailing Address - Fax:717-270-8900
Practice Address - Street 1:801 ORANGE ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7033
Practice Address - Country:US
Practice Address - Phone:717-270-6900
Practice Address - Fax:717-270-8900
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-005582-L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001125350Medicaid
PA431582M63Medicare ID - Type Unspecified
PA001125350Medicaid