Healthcare Provider Details

I. General information

NPI: 1427320175
Provider Name (Legal Business Name): MICHAEL PHILLIP FERMIN VIOLAGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 HIGHWAY 54 W
FAYETTEVILLE GA
30214-4526
US

IV. Provider business mailing address

565 COAL VALLEY RD
JEFFERSON HILLS PA
15025-3703
US

V. Phone/Fax

Practice location:
  • Phone: 770-719-5630
  • Fax:
Mailing address:
  • Phone: 412-267-6281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number109329
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD452333
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD452333
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number109329
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: