Healthcare Provider Details

I. General information

NPI: 1336725100
Provider Name (Legal Business Name): MIGUEL AGUDELO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E MOUNTAIN DR
WILKES BARRE PA
18711-0028
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-808-5780
  • Fax: 570-808-5753
Mailing address:
  • Phone: 570-808-5780
  • Fax: 570-808-5753

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 Code207RI0008X
TaxonomyHepatology Physician
License NumberMD484780
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: