Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | MD05794L | PA |
Y | 207RI0011X | Interventional Cardiology | MD057974L | PA |
NPI | 1013938877 |
---|---|
Provider Name | Dr. George James Antalis |
First Address | Leetsdale, PA 15056 |
Second Address | Leetsdald, PA 15056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 16/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017024830001 | (05) | PA |
F99777 | (02) |