Provider Demographics
NPI:1558538074
Name:LETIZIO, ANTHONY MICHAEL II (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:LETIZIO
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:857 MONTGOMERY AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1541
Mailing Address - Country:US
Mailing Address - Phone:610-664-2951
Mailing Address - Fax:610-664-2131
Practice Address - Street 1:857 MONTGOMERY AVE FL 2
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19072
Practice Address - Country:US
Practice Address - Phone:610-664-2951
Practice Address - Fax:610-664-2131
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS014724207RA0401X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA347727Medicare PIN