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General NPI Number Information
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NPI Number | 1194760231
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE PAIN CARE PHYSICIANS
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 10/07/2011
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Provider Practice Location Address
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Address Line | 1034 GROVE ST
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City | MEADVILLE
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State | PA
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Zip | 16335-2945
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Country | US
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Telephone | 814-333-5736
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Fax | 814-333-5819
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Provider Business Mailing Address
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Address Line | 1034 GROVE STREET
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City | MEADVILLE
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State | PA
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Zip | 16335-2945
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Country | US
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Telephone | 814-333-5736
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Fax | 814-333-5832
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTHONY J COLANTONIO
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Credential | MD
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Telephone | 814-333-5736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | MD421359
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License Number State | PA
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