Provider Demographics
NPI:1730101858
Name:CERRATO, ATHOS R (DO)
Entity Type:Individual
Prefix:
First Name:ATHOS
Middle Name:R
Last Name:CERRATO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 CONCORD PIKE STE 290
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2908
Mailing Address - Country:US
Mailing Address - Phone:856-981-4220
Mailing Address - Fax:
Practice Address - Street 1:1120 W TOWNSHIP LINE RD FL 2
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4930
Practice Address - Country:US
Practice Address - Phone:877-286-5115
Practice Address - Fax:866-286-4935
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-005690L207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ203108296OtherTAX ID
NJ8831807Medicaid
NJ052568Medicare ID - Type Unspecified
NJ8831807Medicaid
PA052568UHTMedicare PIN