Healthcare Provider Details

I. General information

NPI: 1790489276
Provider Name (Legal Business Name): DELENA MARIN VANVALKENBURG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 CONANT ST STE 101
BEVERLY MA
01915-1659
US

IV. Provider business mailing address

PO BOX 24532
NEW YORK NY
10087-4532
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-1919
  • Fax: 978-927-6102
Mailing address:
  • Phone: 781-744-8771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1026312
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: