Provider Demographics
NPI:1821104662
Name:COTRONEA, ANTHONY M (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:COTRONEA
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 1:608 N GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-4159
Mailing Address - Country:US
Mailing Address - Phone:315-336-8260
Mailing Address - Fax:315-314-8536
Practice Address - Street 1:608 N GEORGE ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-4159
Practice Address - Country:US
Practice Address - Phone:315-336-8260
Practice Address - Fax:315-314-8536
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01186805Medicaid
10031653OtherCDPHP
NY5950354OtherAETNA
NY085473OtherMVP
Y029134OtherCHAMPUS
NYP010178689OtherBLUE CROSS
Y029134OtherCHAMPUS
E94206Medicare UPIN