Healthcare Provider Details

I. General information

NPI: 1518224575
Provider Name (Legal Business Name): ANTHONY M. CARRATO, M.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 N CHURCH ST
HAZLETON PA
18201-1800
US

IV. Provider business mailing address

943 N CHURCH ST
HAZLETON PA
18201-1800
US

V. Phone/Fax

Practice location:
  • Phone: 570-450-6440
  • Fax: 570-450-6442
Mailing address:
  • Phone: 570-450-6440
  • Fax: 570-450-6442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0015907990006
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: ANTHONY M CARRATO
Title or Position: PRESIDENT
Credential: MD
Phone: 570-450-6440