Provider Demographics
NPI:1538131495
Name:BARTKOWIAK, ANTHONY J (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:BARTKOWIAK
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 1:1414 9TH AVE
Mailing Address - Street 2:STATION MEDICAL CENTER
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-2454
Mailing Address - Country:US
Mailing Address - Phone:814-946-1655
Mailing Address - Fax:
Practice Address - Street 1:1414 9TH AVE
Practice Address - Street 2:STATION MEDICAL CENTER
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2454
Practice Address - Country:US
Practice Address - Phone:814-946-1655
Practice Address - Fax:814-949-7616
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068354L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017484910001Medicare ID - Type Unspecified
G77336Medicare UPIN
PA026946Medicare ID - Type Unspecified