Provider Demographics
NPI:1770526758
Name:AVALLONE, MICHAEL F JR (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:AVALLONE
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 COTTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1421
Mailing Address - Country:US
Mailing Address - Phone:215-332-9666
Mailing Address - Fax:215-332-1436
Practice Address - Street 1:2813 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1421
Practice Address - Country:US
Practice Address - Phone:215-332-9666
Practice Address - Fax:215-332-1436
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006814L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4201397OtherAETNA HMO PROVIDER NUMBER
PA0468357000OtherKEYSTONE PROVIDER NUMBER
PAE64304Medicare UPIN
PA638098GDQMedicare ID - Type Unspecified