Healthcare Provider Details

I. General information

NPI: 1538197835
Provider Name (Legal Business Name): ANTHONY VALENTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 N VINE ST
HAZLETON PA
18201-5852
US

IV. Provider business mailing address

12 W 17TH ST
HAZLETON PA
18201-2503
US

V. Phone/Fax

Practice location:
  • Phone: 570-455-0923
  • Fax: 570-455-4034
Mailing address:
  • Phone: 570-455-0923
  • Fax: 570-455-4034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD042324L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier653384
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: