Provider Demographics
NPI:1043281595
Name:CHAMOUN, ANTONIO J (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:J
Last Name:CHAMOUN
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 1:3025 C G ZINN RD
Mailing Address - Street 2:
Mailing Address - City:THORNDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19372-1131
Mailing Address - Country:US
Mailing Address - Phone:610-384-2211
Mailing Address - Fax:610-384-2340
Practice Address - Street 1:3025 C G ZINN RD
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:PA
Practice Address - Zip Code:19372-1131
Practice Address - Country:US
Practice Address - Phone:610-384-2211
Practice Address - Fax:610-384-2340
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071379L207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011636490001Medicaid
PA2398859000OtherINDEPENDENCE BLUE CROSS
PAH43403Medicare UPIN
PA083883FGMMedicare ID - Type Unspecified