Provider Demographics
NPI:1548214695
Name:MARCANTONIO, FRANK WILLIAM (PA-C)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:WILLIAM
Last Name:MARCANTONIO
Suffix:
Gender:M
Credentials:PA-C
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 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-612-4000
Mailing Address - Fax:215-807-8235
Practice Address - Street 1:1250 S CEDAR CREST BLVD STE 310
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103
Practice Address - Country:US
Practice Address - Phone:610-402-6890
Practice Address - Fax:610-402-6892
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052298363A00000X, 363AS0400X
NJ25MP00160000363AS0400X
DEC50000449363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007705250011Medicaid
DEG01050OtherMC GROUP #
PA1007705250011Medicaid
DE015206S50Medicare ID - Type Unspecified
NJ234834C04Medicare PIN
PAQ27270Medicare UPIN