Healthcare Provider Details

I. General information

NPI: 1447243787
Provider Name (Legal Business Name): ANTONIO PANEBIANCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 MILL CREEK RD
MACUNGIE PA
18062-8824
US

IV. Provider business mailing address

2560 MILL CREEK RD
MACUNGIE PA
18062-8824
US

V. Phone/Fax

Practice location:
  • Phone: 484-221-3717
  • Fax: 610-351-1158
Mailing address:
  • Phone: 484-221-3717
  • Fax: 610-351-1158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD028954L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: