Provider Demographics
NPI:1811984354
Name:PANTELIDIS, ANASTASIOS GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:ANASTASIOS
Middle Name:GEORGE
Last Name:PANTELIDIS
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 1:601 AVERY ST STE 501
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5192
Mailing Address - Country:US
Mailing Address - Phone:304-588-8683
Mailing Address - Fax:304-422-3924
Practice Address - Street 1:800 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5340
Practice Address - Country:US
Practice Address - Phone:304-424-2590
Practice Address - Fax:304-422-3924
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19249207L00000X
OH35074277207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5700136000Medicaid
OH2125177Medicaid
0884851Medicare ID - Type Unspecified
WV5700136000Medicaid
OH2125177Medicaid
0884853Medicare ID - Type Unspecified
0884852Medicare ID - Type Unspecified