Provider Demographics
NPI:1750327490
Name:MINISSALE, ANTHONY ALBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ALBERT
Last Name:MINISSALE
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 1:325 S BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-2608
Mailing Address - Country:US
Mailing Address - Phone:717-849-5341
Mailing Address - Fax:717-849-5329
Practice Address - Street 1:325 S BELMONT ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2608
Practice Address - Country:US
Practice Address - Phone:717-849-5341
Practice Address - Fax:717-849-5329
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 1861 L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0682223Medicaid
D66333Medicare UPIN
41450Medicare ID - Type Unspecified