Healthcare Provider Details

I. General information

NPI: 1417306705
Provider Name (Legal Business Name): SAMUEL ANTHONY VALLETTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LOCUST AVE
WASHINGTON PA
15301-3397
US

IV. Provider business mailing address

400 LOCUST AVE
WASHINGTON PA
15301-3397
US

V. Phone/Fax

Practice location:
  • Phone: 724-222-9300
  • Fax: 724-228-1856
Mailing address:
  • Phone: 724-222-9300
  • Fax: 724-228-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD468324
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD468324
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: