Provider Demographics
NPI:1194725598
Name:BRUTICO, ANTHONY CARMEN (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:CARMEN
Last Name:BRUTICO
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:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:
Practice Address - Street 1:940 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1007
Practice Address - Country:US
Practice Address - Phone:570-346-7900
Practice Address - Fax:570-963-5060
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025444E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011941970002Medicaid
PA411607Medicare ID - Type Unspecified
PA0011941970002Medicaid