Provider Demographics
NPI:1851366082
Name:TALENTI, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:TALENTI
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 1:1860 FAIR AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-2108
Mailing Address - Country:US
Mailing Address - Phone:570-253-3391
Mailing Address - Fax:
Practice Address - Street 1:1860 FAIR AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-2108
Practice Address - Country:US
Practice Address - Phone:570-253-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042285L207RG0100X
NY194300207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001212132Medicaid
PA100014272OtherRR MEDICARE PIN
NY01411687Medicaid
NY01411687Medicaid
E55863Medicare UPIN
PA001212132Medicaid
E55863Medicare UPIN
PACC9269OtherRR MEDICARE GROUP