Healthcare Provider Details

I. General information

NPI: 1194760231
Provider Name (Legal Business Name): COMPREHENSIVE PAIN CARE PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 GROVE ST
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: 814-333-5736
  • Fax: 814-333-5832

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: DR. ANTHONY J COLANTONIO
Title or Position: OWNER
Credential: MD
Phone: 814-333-5736