Provider Demographics
NPI:1194258277
Name:DIVELLA, MICHAEL FRANCIS (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:DIVELLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:95 LEONARD AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3368
Mailing Address - Country:US
Mailing Address - Phone:724-206-0610
Mailing Address - Fax:724-503-4156
Practice Address - Street 1:95 LEONARD AVE
Practice Address - Street 2:STE 202
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3368
Practice Address - Country:US
Practice Address - Phone:724-206-0610
Practice Address - Fax:724-503-4156
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA05023838207X00000X
PAOS023838207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery