Provider Demographics
NPI:1083632418
Name:GUIDARELLI, ANTHONY FRED (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:FRED
Last Name:GUIDARELLI
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:PO BOX 3452
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303
Mailing Address - Country:US
Mailing Address - Phone:518-372-6401
Mailing Address - Fax:518-372-1612
Practice Address - Street 1:622 MICHIGAN AVENUE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303
Practice Address - Country:US
Practice Address - Phone:518-372-6401
Practice Address - Fax:518-372-1612
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1055921207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00527353Medicaid
NYCOS1055920OtherWCB
NY10000819OtherCDPHP
NY18115OtherMVP
NY18115OtherMVP
NY00527353Medicaid