1043271703 NPI number — ALVISE G ANTI MD

Table of content: ALVISE G ANTI MD (NPI 1043271703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043271703 NPI number — ALVISE G ANTI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANTI
Provider First Name:
ALVISE
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1043271703
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
551 MIAN ST
Provider Second Line Business Mailing Address:
3RD FLOOR ATTN NICOLLE THE INFOR MEDX GROUP
Provider Business Mailing Address City Name:
JOHNSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-539-5724
Provider Business Mailing Address Fax Number:
814-536-7092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 HOSPITAL DR
Provider Second Line Business Practice Location Address:
MEYERSDALE EMERGENCY PHYSICIANS GROUP
Provider Business Practice Location Address City Name:
MEYERSDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-634-5911
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  MD028801E , 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)