Noelle Dominique Altavilla, RD, LDN
Individual provider Active NPI Registered Dietitian · Hazleton, PA
NPI 1275827008 · NPPES record last updated Aug 21, 2023
Key facts
- NPI
- 1275827008
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- DN003742 (PA)
- Practice address
- 141 N Vine St
Hazleton, PA 18201-5852 - Phone
- (570) 501-6322
- NPI assigned
- Jun 9, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111026000761 | PA | Practitioner - Registered Dietitian Or Nutrition Professional | 3678746278 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lehigh Valley Physician Group | Dietitian, Registered | Current |
Accepting new patients |
| Lehigh Valley Physician Group | Current |
Accepting new patients | |
| Commonwealth Physician Network LLC | Current |
Accepting new patients | |
| Lehigh Valley Physician Group | Current | Accepting new patients | |
| Hazleton Professional Services | Current |
Accepting new patients | |
| Lehigh Valley Physician Group | Current |
Accepting new patients |
Locations
2100 Mack Blvd
Fl 4
Allentown, PA 18103
50 Moisey Dr
Ste 210
Hazle Township, PA 18202
Phone (570) 501-6380
50 Moisey Dr
Ste 101
Hazle Township, PA 18202
Phone (570) 459-2226
141 N Vine St
Hazleton, PA 18201
Phone (570) 454-0500
1000 Alliance Dr
#10
Hazleton, PA 18202
Phone (570) 501-6450
610 Wyoming Ave
Kingston, PA 18704
Phone (570) 288-5441
610 Wyoming Ave
#2
Kingston, PA 18704
Phone (570) 714-1032
4 E Main St
Nanticoke, PA 18634
Phone (570) 258-3939
200 S River St
Plains, PA 18705
Phone (570) 821-1100
Interoperability endpoints
- noelle.altavilla.1@21771.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | |||
| Registered Dietitian | 133V00000X | |||
| Registered Dietitian | 133V00000X | DN003742 | PA | Yes |
Addresses
Primary practice location
141 N Vine St
Hazleton, PA 18201-5852
Mailing address
2100 Mack Blvd FL 4
Allentown, PA 18103-5622
Phone (484) 884-4500
Other practice location 1
2 Poplar St
Kingston, PA 18704-3709
Phone (570) 714-4090
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | noelle.altavilla.1@21771.direct.athenahealth.com |
Other providers in Hazleton, PA
- Ajit M Chikarmane MD PC
- Joseph A Albertine
- Alcoholism and Drug Services of Lower Luzerne County, Inc.
- All Care Home Care Inc
- All Care Hospice Care Inc.
- John Peter Amentler
- American Patient Transport Systems, Inc
- Anesthesia Care Consultants
- Anthony M. Carrato, M.D., PC
- Anthracite Region Center for Independent Living
All providers in Hazleton, PA · Registered Dietitian in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.