Provider Demographics
NPI:1114038387
Name:SHEDLOCK, ANTHONY F (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:F
Last Name:SHEDLOCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 CLARA STREET
Mailing Address - Street 2:
Mailing Address - City:HOUTZDALE
Mailing Address - State:PA
Mailing Address - Zip Code:16651
Mailing Address - Country:US
Mailing Address - Phone:814-378-9716
Mailing Address - Fax:814-378-8940
Practice Address - Street 1:612 CLARA STREET
Practice Address - Street 2:
Practice Address - City:HOUTZDALE
Practice Address - State:PA
Practice Address - Zip Code:16651
Practice Address - Country:US
Practice Address - Phone:814-378-9716
Practice Address - Fax:814-378-8940
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005348L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009830200003Medicaid
PA0009830200003Medicaid
PA105054LDQMedicare ID - Type Unspecified