Provider Demographics
NPI:1891051256
Name:VALENTINO, MICHAEL A (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:VALENTINO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 SPROUL RD STE 25
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3508
Mailing Address - Country:US
Mailing Address - Phone:610-353-6400
Mailing Address - Fax:
Practice Address - Street 1:1999 SPROUL RD STE 25
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3508
Practice Address - Country:US
Practice Address - Phone:610-353-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD452361207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033002190002Medicaid