1013954833 NPI number — MITCHELL A ANOLIK MD PC

Table of content: (NPI 1013954833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013954833 NPI number — MITCHELL A ANOLIK MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MITCHELL A ANOLIK MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013954833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2310 E ALLEGHENY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19134-4401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-427-1111
Provider Business Mailing Address Fax Number:
215-423-7799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2310 E ALLEGHENY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19134-4401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-427-1111
Provider Business Practice Location Address Fax Number:
215-423-7799
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANOLIK
Authorized Official First Name:
MITCHELL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-427-1111

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  MD0155618E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0005886420004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 070011814 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4329255 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000134092 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0057093000 . This is a "KEYSTONE HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7750486001 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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