Provider Demographics
NPI:1164410718
Name:COLAVITA, ANNETTE M (MD)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:M
Last Name:COLAVITA
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1650 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8004
Mailing Address - Country:US
Mailing Address - Phone:215-947-6404
Mailing Address - Fax:215-947-9883
Practice Address - Street 1:1650 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 305
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8004
Practice Address - Country:US
Practice Address - Phone:215-947-6404
Practice Address - Fax:215-947-9883
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2016-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD061666L207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017966860004Medicaid
PA037454Medicare PIN
PAG28754Medicare UPIN