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General NPI Number Information
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NPI Number | 1235343849
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Entity Type | Individual
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Provider Name | ANNE-MARIE P AVALLONE D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 03/10/2021
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Provider Practice Location Address
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Address Line | 2600 GREENBUSH STREET
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City | LAFAYETTE
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State | IN
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Zip | 47904-2477
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Country | US
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Telephone | 765-448-8000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5545
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City | LAFAYETTE
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State | IN
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Zip | 47903-5545
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Country | US
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Telephone | 765-448-8000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 58001929
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 02003373A
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License Number State | IN
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