Provider Demographics
NPI:1821331653
Name:DEVINE, MICHAEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:DEVINE
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 1:104 S. WAYNE AVE.
Mailing Address - Street 2:P.O. BOX #279
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-0279
Mailing Address - Country:US
Mailing Address - Phone:610-486-5980
Mailing Address - Fax:610-273-5596
Practice Address - Street 1:165 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-2846
Practice Address - Country:US
Practice Address - Phone:610-486-5980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD460462207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine