Provider Demographics
NPI:1700171113
Name:VERTICELLI, ADELINE M (MD)
Entity Type:Individual
Prefix:DR
First Name:ADELINE
Middle Name:M
Last Name:VERTICELLI
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 1:2055 WHARTON AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER CHICHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4014
Mailing Address - Country:US
Mailing Address - Phone:215-801-2830
Mailing Address - Fax:
Practice Address - Street 1:1250 S COLLEGEVILLE RD
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2990
Practice Address - Country:US
Practice Address - Phone:610-917-6502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine