Provider Demographics
NPI:1356318026
Name:ANOLIK, MITCHELL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:A
Last Name:ANOLIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2310 E ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4401
Mailing Address - Country:US
Mailing Address - Phone:215-427-1111
Mailing Address - Fax:215-423-7799
Practice Address - Street 1:2310 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19134-4401
Practice Address - Country:US
Practice Address - Phone:215-427-1111
Practice Address - Fax:215-423-7799
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015618E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4329255OtherAETNA
PAP1478461OtherOXFORD
PA025846OtherPTAN MEDICARE
070011814OtherRAILROAD MEDICARE
7750486001OtherCIGNA
PA0057093000OtherKEYSTONE
PA025846OtherPTAN
PA134092OtherBLUE SHIELD
PA30607OtherKEYSTONE MERCY
PA0588642Medicaid
PAB38057Medicare UPIN