Provider Demographics
NPI:1164147328
Name:D'ANTONIO, JACOB ANDREW
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ANDREW
Last Name:D'ANTONIO
Suffix:
Gender:M
Credentials:
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Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:241 CLEARBROOK CT
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-5621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6998 CRIDER RD STE 110
Practice Address - Street 2:
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046-2390
Practice Address - Country:US
Practice Address - Phone:866-874-7483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical