Provider Demographics
NPI:1043271703
Name:ANTI, ALVISE G (MD)
Entity Type:Individual
Prefix:
First Name:ALVISE
Middle Name:G
Last Name:ANTI
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 1:551 MIAN ST
Mailing Address - Street 2:3RD FLOOR ATTN NICOLLE THE INFOR MEDX GROUP
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15901
Mailing Address - Country:US
Mailing Address - Phone:814-539-5724
Mailing Address - Fax:814-536-7092
Practice Address - Street 1:200 HOSPITAL DR
Practice Address - Street 2:MEYERSDALE EMERGENCY PHYSICIANS GROUP
Practice Address - City:MEYERSDALE
Practice Address - State:PA
Practice Address - Zip Code:15552
Practice Address - Country:US
Practice Address - Phone:814-634-5911
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028801E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA161555Medicare ID - Type Unspecified
C32396Medicare UPIN