Provider Demographics
NPI:1548440415
Name:VICTAIN, MICHELLE SUZANNE (DO)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SUZANNE
Last Name:VICTAIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KNOWLSON AVENUE
Mailing Address - Street 2:CHIPPEWA TOWNSHIP
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1634
Mailing Address - Country:US
Mailing Address - Phone:724-891-2100
Mailing Address - Fax:724-891-2734
Practice Address - Street 1:100 KNOWLSON AVE
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1634
Practice Address - Country:US
Practice Address - Phone:724-891-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT010937207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology