Provider Demographics
NPI:1003879560
Name:GIARDINA, ANTHONY (DO)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:GIARDINA
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 1:349 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5120
Mailing Address - Country:US
Mailing Address - Phone:570-288-2300
Mailing Address - Fax:570-288-2298
Practice Address - Street 1:349 PIERCE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5120
Practice Address - Country:US
Practice Address - Phone:570-288-2300
Practice Address - Fax:570-288-2298
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-002974-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017690340002Medicaid
PA627665Medicare ID - Type Unspecified
PA0017690340002Medicaid