Healthcare Provider Details

I. General information

NPI: 1174593958
Provider Name (Legal Business Name): MICHAEL J ATTANASIO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W RITNER ST
PHILADELPHIA PA
19145-4324
US

IV. Provider business mailing address

1701 W RITNER ST
PHILADELPHIA PA
19145-4324
US

V. Phone/Fax

Practice location:
  • Phone: 215-336-2145
  • Fax: 215-336-5732
Mailing address:
  • Phone: 215-336-2145
  • Fax: 215-336-5732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS0008637L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB06296800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: