1194780122 NPI number — ANTHONY DEPIETRO D.C.

Table of content: ANTHONY DEPIETRO D.C. (NPI 1194780122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194780122 NPI number — ANTHONY DEPIETRO D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEPIETRO
Provider First Name:
ANTHONY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1194780122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1536 MAIN ST STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PECKVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18452-2062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-291-4450
Provider Business Mailing Address Fax Number:
570-291-4454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1536 MAIN ST
Provider Second Line Business Practice Location Address:
1ST FLOOR REAR
Provider Business Practice Location Address City Name:
PECKVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18452-2062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-291-4450
Provider Business Practice Location Address Fax Number:
570-291-4454
Provider Enumeration Date:
04/20/2006

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: 111N00000X , with the licence number:  DC008925 , 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: 001998704 . This is a "BLUE CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20045679 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001998704 . This is a "BLUE CARE HMO (FPH)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101168716-0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1058062/7225529 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1194780122 . This is a "GHP FAMILY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 854450 . This is a "OPTUM-UHC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00315312 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 78572-1067 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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