Basic Information
| Provider Information | |||||||||
| NPI: | 1598725087 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VALENCIA | ||||||||
| FirstName: | MARIA TERESA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 390 | ||||||||
| Address2: | |||||||||
| City: | SCRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703467797 | ||||||||
| FaxNumber: | 5703429802 | ||||||||
| Practice Location | |||||||||
| Address1: | 509 N BROAD ST | ||||||||
| Address2: | 3RD FLOOR UNDERWOOD MEMORIAL HOSPITAL | ||||||||
| City: | WOODBURY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568450100 | ||||||||
| FaxNumber: | 8568539334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 07/28/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 25MA03889100 | NJ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 3653102 | 05 | NJ | MEDICAID |