Healthcare Provider Details

I. General information

NPI: 1558866541
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL ANTHONY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD WEST PAVILION, 3RD FLOOR
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

51 N 39TH ST SUITE 603
PHILADELPHIA PA
19104-2689
US

V. Phone/Fax

Practice location:
  • Phone: 215-614-4100
  • Fax: 215-615-0527
Mailing address:
  • Phone: 215-614-4100
  • Fax: 215-615-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOS024606
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: