Provider Demographics
NPI:1740787647
Name:BRUTICO, ANTHONY GABRIEL (DPM)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:GABRIEL
Last Name:BRUTICO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1101
Mailing Address - Country:US
Mailing Address - Phone:570-936-2960
Mailing Address - Fax:570-936-2961
Practice Address - Street 1:409 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-1798
Practice Address - Country:US
Practice Address - Phone:570-936-2960
Practice Address - Fax:570-936-2961
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC0069O9213ES0103X
390200000X
PASC006909213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program