Provider Demographics
NPI:1184667982
Name:MAURIELLO, ANTHONY J (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:MAURIELLO
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 1:554 N DUKE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2225
Mailing Address - Country:US
Mailing Address - Phone:717-299-3524
Mailing Address - Fax:717-299-3552
Practice Address - Street 1:554 N DUKE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2225
Practice Address - Country:US
Practice Address - Phone:717-299-3524
Practice Address - Fax:717-299-3552
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068055L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG88130Medicare UPIN
PA024686Medicare ID - Type Unspecified