Provider Demographics
NPI:1497790018
Name:CULOTTA, ANTHONY J (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:CULOTTA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:100 E CALIFORNIA BLVD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3205
Mailing Address - Country:US
Mailing Address - Phone:626-568-8838
Mailing Address - Fax:626-583-8838
Practice Address - Street 1:800 FAIRMOUNT AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3150
Practice Address - Country:US
Practice Address - Phone:626-568-8838
Practice Address - Fax:626-583-8838
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2016-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA025662207W00000X
GA061228207W00000X
CAA97142207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I180045Medicare PIN