Provider Demographics
NPI:1174564504
Name:COLANTONIO, ANTHONY JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JAMES
Last Name:COLANTONIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 GROVE STREET
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-333-5729
Mailing Address - Fax:814-333-5819
Practice Address - Street 1:1034 GROVE STREET
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2945
Practice Address - Country:US
Practice Address - Phone:814-333-5736
Practice Address - Fax:814-333-5819
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421359207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019660890002Medicaid
PA320575OtherUPMC HEALTH PLAN
PA01477976OtherHIGHMARK BLUE SHIELD
PA0019660980002Medicaid
PA0019660890002Medicaid
PA0019660980002Medicaid
PA070998Medicare ID - Type Unspecified