Provider Demographics
NPI:1801938006
Name:BAZZAN, ANTHONY JOHN (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOHN
Last Name:BAZZAN
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 1:2505 BOULEVARD OF THE GENERALS
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-3698
Mailing Address - Country:US
Mailing Address - Phone:610-630-8600
Mailing Address - Fax:610-630-9599
Practice Address - Street 1:2505 BOULEVARD OF THE GENERALS
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-3698
Practice Address - Country:US
Practice Address - Phone:610-630-8600
Practice Address - Fax:610-630-9599
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042799E207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF03363Medicare UPIN