Provider Demographics
NPI:1801923115
Name:NESPOLA, ANTHONY M (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:M
Last Name:NESPOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15 MEADE ST
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1813
Mailing Address - Country:US
Mailing Address - Phone:570-724-3744
Mailing Address - Fax:570-724-2459
Practice Address - Street 1:15 MEADE ST
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1813
Practice Address - Country:US
Practice Address - Phone:570-724-3744
Practice Address - Fax:570-724-2459
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD018881E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB34585Medicare UPIN