Provider Demographics
NPI:1982680476
Name:SCIALLA, ANTHONY VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:VINCENT
Last Name:SCIALLA
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 1:100 YORK ST
Mailing Address - Street 2:#8D
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5643
Mailing Address - Country:US
Mailing Address - Phone:203-777-2946
Mailing Address - Fax:203-865-5260
Practice Address - Street 1:100 YORK ST
Practice Address - Street 2:#8D
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5643
Practice Address - Country:US
Practice Address - Phone:203-777-2946
Practice Address - Fax:203-865-5260
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14257208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001142579Medicaid
CT010014257CT01OtherANTHEM BLUE CROSS
CT020000352Medicare ID - Type Unspecified
CT001142579Medicaid