Provider Demographics
NPI:1578756946
Name:D'ANTONIO, AMY (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:D'ANTONIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-4874
Mailing Address - Country:US
Mailing Address - Phone:724-857-4004
Mailing Address - Fax:724-857-0983
Practice Address - Street 1:5000 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-4874
Practice Address - Country:US
Practice Address - Phone:724-857-4004
Practice Address - Fax:724-857-0983
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4299712081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH13043Medicare UPIN