Healthcare Provider Details

I. General information

NPI: 1174564504
Provider Name (Legal Business Name): ANTHONY JAMES COLANTONIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 GROVE STREET
MEADVILLE PA
16335-2945
US

IV. Provider business mailing address

1034 GROVE STREET
MEADVILLE PA
16335-2945
US

V. Phone/Fax

Practice location:
  • Phone: 814-333-5736
  • Fax: 814-333-5819
Mailing address:
  • Phone: 814-333-5729
  • Fax: 814-333-5819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD421359
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: