Healthcare Provider Details

I. General information

NPI: 1386743342
Provider Name (Legal Business Name): MEDICAL ASSOCIATES OF NEPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1789 N KEYSER AVE
SCRANTON PA
18508-1250
US

IV. Provider business mailing address

1789 N KEYSER AVE
SCRANTON PA
18508-1250
US

V. Phone/Fax

Practice location:
  • Phone: 570-969-1904
  • Fax: 570-969-2916
Mailing address:
  • Phone: 570-969-1904
  • Fax: 570-969-2916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001817113
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DR. ANTHONY JOSEPH YANNI
Title or Position: PRESIDENT AND CEO
Credential: M.D.
Phone: 570-969-1904