MEDICARE: DR. ANTHONY ANTONELLO JR. 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	207W00000X	Ophthalmology Physician	MD-044041-E	PA
2	207W00000X	Ophthalmology Physician	MD044041E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548265374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY ANTONELLO JR. M.D.

Provider Business Mailing Address
First Line	:	1098 W BALTIMORE PIKE
Second Line	:	SUITE 3302
City	:	MEDIA
State	:	PA
Zip	:	19063-5139
Country	:	US
Telephone Number	:	610-565-6780
Fax Number	:	610-565-9390

Provider Business Practice Location Address
First Line	:	1098 W BALTIMORE PIKE
Second Line	:	SUITE 3302
City	:	MEDIA
State	:	PA
Zip	:	19063-5139
Country	:	US
Telephone Number	:	610-565-6780
Fax Number	:	610-565-9390

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	11/29/2023

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Directions to “ DR. ANTHONY ANTONELLO JR. M.D.” Practice Location

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