Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 25MA07749200 | NJ |
N | 208000000X | Pediatrician | MD421934 | PA |
Y | 2080P0204X | Pediatric Emergency Doctor | 25MA07749200 | NJ |
N | 2080P0204X | Pediatric Emergency Doctor | MD421934 | PA |
NPI | 1144269614 |
---|---|
Provider Name | Michael F. Maraventano |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Mount Holly, NJ 08060-2038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 03/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0044270 | (05) | NJ |
2416654000 | AMERIHEALTH (01) | NJ |
I17382 | (02) |