Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | SC002409L | PA |
NPI | 1063417640 |
---|---|
Provider Name | Anthony C Anzalone |
First Address | Willow Grove, PA 19090-1700 |
Second Address | Willow Grove, PA 19090-1700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 15/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00126855902 | (05) | PA |
480018099 | PALMETTOGBA-RRMEDICARE (01) | |
T44700 | (02) |