Provider Demographics
NPI:1447243787
Name:PANEBIANCO, ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:PANEBIANCO
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 1:2560 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8824
Mailing Address - Country:US
Mailing Address - Phone:484-221-3717
Mailing Address - Fax:610-351-1158
Practice Address - Street 1:2560 MILL CREEK RD
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-8824
Practice Address - Country:US
Practice Address - Phone:484-221-3717
Practice Address - Fax:610-351-1158
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028954L208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0040153000OtherINDEPENDENCE BLUE CROSS
PA017216OtherHIGHMARK PIN
PA50026859OtherCAPITAL BLUE CROSS
PA0006407420003Medicaid
PA0006407420004Medicaid
PA0040153000OtherINDEPENDENCE BLUE CROSS
B32873Medicare UPIN
PA017216V8GMedicare PIN