Healthcare Provider Details

I. General information

NPI: 1760688105
Provider Name (Legal Business Name): VALENTINA J. INTAGLIATA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 W MAIN ST RM 1421
CHARLOTTESVILLE VA
22903-2821
US

IV. Provider business mailing address

1105 W MAIN ST RM 1421
CHARLOTTESVILLE VA
22903-2821
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-5411
  • Fax:
Mailing address:
  • Phone: 434-924-5411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116019777
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101247497
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number0101247497
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: