Provider Demographics
NPI:1538297791
Name:VANNORMAN, ANTHONY JOSEPH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:VANNORMAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:419 W PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2211
Practice Address - Country:US
Practice Address - Phone:724-837-5810
Practice Address - Fax:724-837-8938
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431212207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVVA6037491Medicare PIN
111841HXBMedicare PIN
VA1956781OtherHIGHMARK
1563885OtherGATEWAY
PA1018916790001Medicaid
WV3810012907Medicaid
PA411699OtherUPMC