Basic Information
| Provider Information | |||||||||
| NPI: | 1013954833 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MITCHELL A ANOLIK MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2310 E ALLEGHENY AVE | ||||||||
| Address2: | |||||||||
| City: | PHILA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191344401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154271111 | ||||||||
| FaxNumber: | 2154237799 | ||||||||
| Practice Location | |||||||||
| Address1: | 2310 E ALLEGHENY AVE | ||||||||
| Address2: | |||||||||
| City: | PHILA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191344401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154271111 | ||||||||
| FaxNumber: | 2154237799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 12/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | ANOLIK | ||||||||
| AuthorizedOfficialFirstName: | MITCHELL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2154271111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | MD0155618E | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 0005886420004 | 05 | PA | MEDICAID | 070011814 | 01 | PA | RAILROAD MEDICARE | OTHER | 4329255 | 01 | PA | AETNA | OTHER | 000134092 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 0057093000 | 01 | PA | KEYSTONE HMO | OTHER | 7750486001 | 01 | PA | CIGNA | OTHER |