MEDICARE: ATHOS R CERRATO DO

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	207LA0401X	Addiction Medicine (Anesthesiology) Physician	OS-005690L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	203108296	OTHER	NJ	TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730101858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATHOS R CERRATO DO

Provider Business Mailing Address
First Line	:	2207 CONCORD PIKE STE 290
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19803-2908
Country	:	US
Telephone Number	:	856-981-4220
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 W TOWNSHIP LINE RD FL 2
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-4930
Country	:	US
Telephone Number	:	877-286-5115
Fax Number	:	866-286-4935

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	08/03/2021

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