1972508794 NPI number — ANTHONY BARON COLANGELO M.D.

Table of content: THEADORA SHULMAN (NPI 1750898557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972508794 NPI number — ANTHONY BARON COLANGELO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLANGELO
Provider First Name:
ANTHONY
Provider Middle Name:
BARON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1972508794
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/20/2006
NPI Reactivation Date:
03/24/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 PARK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLWOOD CITY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16117-2025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-758-4537
Provider Business Mailing Address Fax Number:
724-758-7344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLWOOD CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16117-2025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-758-4537
Provider Business Practice Location Address Fax Number:
724-758-7344
Provider Enumeration Date:
06/17/2005

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: 173000000X , with the licence number:  022953E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: 022953E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 104011 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4239283 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 200817080 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1622543 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 200817080 . This is a "TRICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1010186390001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1010607 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 244680 . This is a "HEALTHASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 6225598-002 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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