MEDICARE: DR. ROSSANA I AVELINO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD075600L	PA
2	2084P0804X	Child & Adolescent Psychiatry Physician	MD075600L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457464489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSSANA I AVELINO M.D.

Provider Business Mailing Address
First Line	:	3440 MARKET ST
Second Line	:	SUITE 200
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104
Country	:	US
Telephone Number	:	215-590-7555
Fax Number	:	215-590-7387

Provider Business Practice Location Address
First Line	:	3440 MARKET ST
Second Line	:	SUITE 200
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3325
Country	:	US
Telephone Number	:	215-590-7555
Fax Number	:	215-590-7387

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	01/12/2009

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