Provider Demographics
NPI:1013954833
Name:MITCHELL A ANOLIK MD PC
Entity Type:Organization
Organization Name:MITCHELL A ANOLIK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANOLIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-427-1111
Mailing Address - Street 1:2310 E ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4401
Mailing Address - Country:US
Mailing Address - Phone:215-427-1111
Mailing Address - Fax:215-423-7799
Practice Address - Street 1:2310 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19134-4401
Practice Address - Country:US
Practice Address - Phone:215-427-1111
Practice Address - Fax:215-423-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0155618E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005886420004Medicaid
PA070011814OtherRAILROAD MEDICARE
PA4329255OtherAETNA
PA000134092OtherHIGHMARK BLUE SHIELD
PA0057093000OtherKEYSTONE HMO
PA7750486001OtherCIGNA
PA7750486001OtherCIGNA
PA0057093000OtherKEYSTONE HMO