Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | OS014724 | PA |
Y | 111NI0900X | Internist | OS014724 | PA |
N | 207RA0401X | Internist - Addiction Medicine | OS014724 | PA |
NPI | 1558538074 |
---|---|
Provider Name | Dr. Anthony Michael Letizio II |
First Address | Penn Valley, PA 19072-1541 |
Second Address | Penn Valley, PA 19072 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2008 |
Last Update Date | 19/11/2018 |