Healthcare Provider Details

I. General information

NPI: 1144269614
Provider Name (Legal Business Name): MICHAEL F. MARAVENTANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MADISON AVE CHOP CARE NETWORK @VIRTUA MEMORIAL HOSPITAL
MOUNT HOLLY NJ
08060-2038
US

IV. Provider business mailing address

100 E PENN SQ 9TH FL
PHILADELPHIA PA
19107-3323
US

V. Phone/Fax

Practice location:
  • Phone: 609-914-6226
  • Fax: 609-261-5842
Mailing address:
  • Phone: 267-425-9258
  • Fax: 267-425-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07749200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberMD421934
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD421934
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number25MA07749200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: