Provider Demographics
NPI:1326078114
Name:NANFARA, MARCANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:MARCANTONIO
Middle Name:
Last Name:NANFARA
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 1:1907 NEW ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225
Mailing Address - Country:US
Mailing Address - Phone:609-484-9119
Mailing Address - Fax:609-484-9965
Practice Address - Street 1:1907 NEW ROAD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225
Practice Address - Country:US
Practice Address - Phone:609-484-9119
Practice Address - Fax:609-484-9965
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05346500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151595001OtherAMERIHEALTH HMO
1044155OtherHORIZON NJ HEALTH FAMILY
NJ2151595001OtherAMERIHEALTH
4202658OtherAETNA PPO
F13780OtherAMERIHEALTH ADMINISTRATOR
1467506OtherPPO
47351OtherAETNA COP OFFICE
NJ7220006Medicaid
NJK3831OtherHMO HORIZON
NJ3126152OtherCIGNA
495148OtherAETNA HMO
2K2891OtherHEALTHNET
NJ83475OtherAMERIGROUP
NJK3831OtherHMO HORIZON
NJ3126152OtherCIGNA