MEDICARE: MICHAEL F AVALLONE JR. D.O.

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	207Q00000X	Family Medicine Physician	OS006814L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4201397	OTHER	PA	AETNA HMO PROVIDER NUMBER
2	0468357000	OTHER	PA	KEYSTONE PROVIDER NUMBER

General Provider Information

NPI Number	:	1770526758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL F AVALLONE JR. D.O.

Provider Business Mailing Address
First Line	:	2813 COTTMAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1421
Country	:	US
Telephone Number	:	215-332-9666
Fax Number	:	215-332-1436

Provider Business Practice Location Address
First Line	:	2813 COTTMAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1421
Country	:	US
Telephone Number	:	215-332-9666
Fax Number	:	215-332-1436

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	05/26/2020

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