Provider Demographics
NPI:1659486033
Name:PALAZZOLO, MICHAEL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:PALAZZOLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1021 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3827
Mailing Address - Country:US
Mailing Address - Phone:215-884-7411
Mailing Address - Fax:
Practice Address - Street 1:821 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 205
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-8365
Practice Address - Country:US
Practice Address - Phone:215-379-4001
Practice Address - Fax:215-379-8153
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-036710E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1198848Medicaid
PAB40667Medicare UPIN
PA1198848Medicaid