Healthcare Provider Details

I. General information

NPI: 1730101858
Provider Name (Legal Business Name): ATHOS R CERRATO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W TOWNSHIP LINE RD FL 2
HAVERTOWN PA
19083-4930
US

IV. Provider business mailing address

2207 CONCORD PIKE STE 290
WILMINGTON DE
19803-2908
US

V. Phone/Fax

Practice location:
  • Phone: 877-286-5115
  • Fax: 866-286-4935
Mailing address:
  • Phone: 856-981-4220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberOS-005690L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: