Provider Demographics
NPI:1538129507
Name:GENTILE, ANTHONY F (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:F
Last Name:GENTILE
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:PO BOX 18119
Mailing Address - Street 2:MOB # 310
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-0119
Mailing Address - Country:US
Mailing Address - Phone:412-469-7932
Mailing Address - Fax:412-469-5493
Practice Address - Street 1:3212 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MUNHALL
Practice Address - State:PA
Practice Address - Zip Code:15120-3230
Practice Address - Country:US
Practice Address - Phone:412-464-1802
Practice Address - Fax:412-464-1804
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012081E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0805931Medicaid
PA136790Medicare ID - Type Unspecified
PA0805931Medicaid