1215097100 NPI number — ANTHONY C CANTERNA MD LLC

Table of content: (NPI 1215097100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215097100 NPI number — ANTHONY C CANTERNA MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANTHONY C CANTERNA MD LLC
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:
1215097100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
940 AIRPORT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-228-4658
Provider Business Mailing Address Fax Number:
724-228-9151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
195 W BEAU ST
Provider Second Line Business Practice Location Address:
JEFFERSON COURT PLAZA
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301-4401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-222-5940
Provider Business Practice Location Address Fax Number:
724-222-8940
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CANTERNA
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
724-228-4658

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1014882410001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00154861 . This is a "BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com