Provider Demographics
NPI:1962467290
Name:DELLAPENNA, MICHAEL JEFFERY (PA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JEFFERY
Last Name:DELLAPENNA
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:100 RICE MINE ROAD LOOP
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2419
Mailing Address - Country:US
Mailing Address - Phone:205-752-1800
Mailing Address - Fax:205-752-1891
Practice Address - Street 1:100 RICE MINE ROAD LOOP
Practice Address - Street 2:SUITE 205
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2419
Practice Address - Country:US
Practice Address - Phone:205-752-1800
Practice Address - Fax:205-752-1891
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2009-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALPA009363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529932889Medicaid
ALC75369Medicare UPIN
AL529932889Medicaid