Provider Demographics
NPI:1780669507
Name:VALENTA, VAN ALAN (MD)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:ALAN
Last Name:VALENTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MEMORIAL AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3732
Mailing Address - Country:US
Mailing Address - Phone:301-723-4965
Mailing Address - Fax:301-777-4983
Practice Address - Street 1:600 MEMORIAL AVE
Practice Address - Street 2:MEMORIAL HOSPITAL
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3765
Practice Address - Country:US
Practice Address - Phone:301-723-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD 0037252207L00000X
TXF 2079207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS516R328Medicare PIN