MEDICARE: DR. FORTUNATA VERDETTI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	MD431433	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386851855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FORTUNATA VERDETTI M.D.

Provider Business Mailing Address
First Line	:	P O BOX 1096
Second Line	:
City	:	KINGSTON
State	:	PA
Zip	:	18704-0096
Country	:	US
Telephone Number	:	570-208-5534
Fax Number	:	570-208-5548

Provider Business Practice Location Address
First Line	:	2128 BLAKESLEE BOULEVARD DR E
Second Line	:
City	:	LEHIGHTON
State	:	PA
Zip	:	18235-9619
Country	:	US
Telephone Number	:	610-402-5369
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	05/02/2025

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