Provider Demographics
NPI:1972508794
Name:COLANGELO, ANTHONY BARON (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:BARON
Last Name:COLANGELO
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 1:510 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-2025
Mailing Address - Country:US
Mailing Address - Phone:724-758-4537
Mailing Address - Fax:724-758-7344
Practice Address - Street 1:510 PARK AVE
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-2025
Practice Address - Country:US
Practice Address - Phone:724-758-4537
Practice Address - Fax:724-758-7344
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2015-10-01
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
PA022953E173000000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104011OtherUPMC
PA4239283OtherAETNA
PA200817080OtherUNITED HEALTHCARE
PA1622543OtherHIGHMARK BC/BS
PA200817080OtherTRICARE
PA1010186390001Medicaid
PA1010607OtherGATEWAY
PA244680OtherHEALTHASSURANCE
PA6225598-002OtherCIGNA
PA1010186390001Medicaid
PA404624Medicare ID - Type Unspecified