Provider Demographics
NPI:1013938877
Name:ANTALIS, GEORGE JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:JAMES
Last Name:ANTALIS
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 1:12 QV SHOPPING CENTER, STE 2A
Mailing Address - Street 2:OHIO RIVER BLVD
Mailing Address - City:LEETSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15056
Mailing Address - Country:US
Mailing Address - Phone:724-773-4502
Mailing Address - Fax:412-749-6787
Practice Address - Street 1:QV SHOPPING CENTER
Practice Address - Street 2:SUITE 2A OHIO RIVER BLVD
Practice Address - City:LEETSDALD
Practice Address - State:PA
Practice Address - Zip Code:15056
Practice Address - Country:US
Practice Address - Phone:724-773-4502
Practice Address - Fax:412-749-6787
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD05794L207RC0000X
PAMD057974L207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017024830001Medicaid
PA010634LCKMedicare PIN
F99777Medicare UPIN