MEDICARE: DR. MITCHELL A ANOLIK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	MD015618E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	025846	OTHER	PA	PTAN MEDICARE
4	070011814	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4329255	OTHER	PA	AETNA
2	P1478461	OTHER	PA	OXFORD
5	7750486001	OTHER		CIGNA
6	0057093000	OTHER	PA	KEYSTONE
7	025846	OTHER	PA	PTAN
8	134092	OTHER	PA	BLUE SHIELD
9	30607	OTHER	PA	KEYSTONE MERCY
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356318026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL A ANOLIK M.D.

Provider Business Mailing Address
First Line	:	2310 E ALLEGHENY AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19134-4401
Country	:	US
Telephone Number	:	215-427-1111
Fax Number	:	215-423-7799

Provider Business Practice Location Address
First Line	:	2310 E ALLEGHENY AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19134-4401
Country	:	US
Telephone Number	:	215-427-1111
Fax Number	:	215-423-7799

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	06/29/2010

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