Basic Information
| Provider Information | |||||||||
| NPI: | 1538129507 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GENTILE | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 18119 | ||||||||
| Address2: | MOB # 310 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152360119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124697932 | ||||||||
| FaxNumber: | 4124695493 | ||||||||
| Practice Location | |||||||||
| Address1: | 3212 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | MUNHALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151203230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124641802 | ||||||||
| FaxNumber: | 4124641804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 09/16/2010 | ||||||||
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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 | 174400000X | MD012081E | PA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 0805931 | 05 | PA | MEDICAID |