Provider Demographics
NPI:1942598842
Name:DAMIN, ANTHONY C (PA-C)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:C
Last Name:DAMIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4472
Mailing Address - Country:US
Mailing Address - Phone:814-942-1166
Mailing Address - Fax:814-942-1169
Practice Address - Street 1:3000 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4472
Practice Address - Country:US
Practice Address - Phone:814-942-1166
Practice Address - Fax:814-942-1169
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002690363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical