Healthcare Provider Details

I. General information

NPI: 1588848600
Provider Name (Legal Business Name): MICHAEL PATRICK VALDERRAMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 HARPER RD
BECKLEY WV
25801-3397
US

IV. Provider business mailing address

32 DODSON AVE
WILMINGTON DE
19804-2021
US

V. Phone/Fax

Practice location:
  • Phone: 681-532-8444
  • Fax:
Mailing address:
  • Phone: 681-532-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0010927
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC1-0029807
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36244
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: