Basic Information
| Provider Information | |||||||||
| NPI: | 1356318026 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANOLIK | ||||||||
| FirstName: | MITCHELL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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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: | 03/02/2006 | ||||||||
| LastUpdateDate: | 06/29/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | MD015618E | PA | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 4329255 | 01 | PA | AETNA | OTHER | P1478461 | 01 | PA | OXFORD | OTHER | 025846 | 01 | PA | PTAN MEDICARE | OTHER | 070011814 | 01 | RAILROAD MEDICARE | OTHER | 7750486001 | 01 | CIGNA | OTHER | 0057093000 | 01 | PA | KEYSTONE | OTHER | 025846 | 01 | PA | PTAN | OTHER | 134092 | 01 | PA | BLUE SHIELD | OTHER | 30607 | 01 | PA | KEYSTONE MERCY | OTHER | 0588642 | 05 | PA | MEDICAID |