MEDICARE: DR. ANTHONY MICHAEL LETIZIO D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	OS014724	PA
2	207RA0401X	Addiction Medicine (Internal Medicine) Physician	OS014724	PA

General Provider Information

NPI Number	:	1558538074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY MICHAEL LETIZIO D.O.

Provider Business Mailing Address
First Line	:	1311 S CARLISLE ST UNIT D
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-4810
Country	:	US
Telephone Number	:	814-806-5206
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 S 18TH ST FL 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-2905
Country	:	US
Telephone Number	:	814-806-5206
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2008
Last Update Date	:	06/09/2026

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