Provider Demographics
NPI:1144269614
Name:MARAVENTANO, MICHAEL F (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:MARAVENTANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:9TH FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9258
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:175 MADISON AVE
Practice Address - Street 2:CHOP CARE NETWORK @VIRTUA MEMORIAL HOSPITAL
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2038
Practice Address - Country:US
Practice Address - Phone:609-914-6226
Practice Address - Fax:609-261-5842
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2014-11-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07749200208000000X, 2080P0204X
PAMD4219342080P0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0044270Medicaid
NJ2416654000OtherAMERIHEALTH
NJ2416654000OtherAMERIHEALTH
NJ083762Medicare ID - Type Unspecified