Healthcare Provider Details

I. General information

NPI: 1558538074
Provider Name (Legal Business Name): ANTHONY MICHAEL LETIZIO II D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 SHOEMAKER ROAD
KING OF PRUSSIA PA
19406-4201
US

IV. Provider business mailing address

857 MONTGOMERY AVE FL 2
PENN VALLEY PA
19072-1541
US

V. Phone/Fax

Practice location:
  • Phone: 484-378-2424
  • Fax: 484-723-5324
Mailing address:
  • Phone: 610-664-2951
  • Fax: 610-664-2131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberOS014724
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS014724
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: