Provider Demographics
NPI:1275928145
Name:FIORENTINO, MICHELE NICOLE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:NICOLE
Last Name:FIORENTINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 TORY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4735 OGLETOWN STANTON RD STE 3301
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-7021
Practice Address - Country:US
Practice Address - Phone:302-623-4370
Practice Address - Fax:302-623-4375
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN68115208600000X
DEC1-0027189208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery