Provider Demographics
NPI:1356091086
Name:DELLAVALLE, RAPHAELLA MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:RAPHAELLA
Middle Name:MICHELLE
Last Name:DELLAVALLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAPHAELLA
Other - Middle Name:MICHELLE
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1200 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3788
Mailing Address - Country:US
Mailing Address - Phone:215-481-2000
Mailing Address - Fax:
Practice Address - Street 1:3500 N BROAD ST
Practice Address - Street 2:ROOM 001A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-4106
Practice Address - Country:US
Practice Address - Phone:215-707-7198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD488429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program