Provider Demographics
NPI:1588631931
Name:DALESSIO, ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:DALESSIO
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 1:1901 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-7915
Mailing Address - Country:US
Mailing Address - Phone:630-725-2768
Mailing Address - Fax:630-725-2783
Practice Address - Street 1:400 PENN CENTER BLVD
Practice Address - Street 2:SUITE 602
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-5613
Practice Address - Country:US
Practice Address - Phone:412-823-3782
Practice Address - Fax:412-823-5041
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056882L207P00000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD056882LOtherLICENSE NUMBER
PA0015373520005Medicaid
PA787175K7PMedicare ID - Type UnspecifiedPROVIDER NUMBER
PA78175ZAAQMedicare PIN
PA0015373520005Medicaid