Provider Demographics
NPI:1861779399
Name:MARK C VALENTE DO PA
Entity type:Organization
Organization Name:MARK C VALENTE DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIVARAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-550-5300
Mailing Address - Street 1:5566 W MAIN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-3669
Mailing Address - Country:US
Mailing Address - Phone:214-550-5300
Mailing Address - Fax:214-618-7733
Practice Address - Street 1:1851 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3852
Practice Address - Country:US
Practice Address - Phone:214-550-5300
Practice Address - Fax:214-618-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty