Provider Demographics
NPI:1174593958
Name:ATTANASIO, MICHAEL J (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:ATTANASIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1701 W RITNER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-4324
Mailing Address - Country:US
Mailing Address - Phone:215-336-2145
Mailing Address - Fax:215-336-5732
Practice Address - Street 1:1701 W RITNER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4324
Practice Address - Country:US
Practice Address - Phone:215-336-2145
Practice Address - Fax:215-336-5732
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS0008637L207Q00000X
NJ25MB06296800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07292032Medicaid
NJ035031ZGH1Medicare PIN
PA07292032Medicaid
PAF92960Medicare UPIN