1275528861 NPI number — JOHN A AVALLONE DO

Table of content: JOHN A AVALLONE DO (NPI 1275528861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275528861 NPI number — JOHN A AVALLONE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AVALLONE
Provider First Name:
JOHN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275528861
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 UNIVERSITY DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
NEWTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18940-1873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-710-5522
Provider Business Mailing Address Fax Number:
215-710-5181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1203 LANGHORNE NEWTOWN RD STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANGHORNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19047-1211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-364-9100
Provider Business Practice Location Address Fax Number:
267-364-9101
Provider Enumeration Date:
09/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  OS007182L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1023483 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0710172000 . This is a "KEYSTONE IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4471294 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 766318 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 8040722 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0014636060006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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