Provider Demographics
NPI:1215910005
Name:ELISCO, ANTHONY J (DO)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:ELISCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 LYNN BLVD
Mailing Address - Street 2:
Mailing Address - City:FARRELL
Mailing Address - State:PA
Mailing Address - Zip Code:16121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1112 S MILL ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-4629
Practice Address - Country:US
Practice Address - Phone:724-658-4564
Practice Address - Fax:724-657-8563
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS001957L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000637953Medicaid
PA041798RN0Medicare PIN
PAB96658Medicare UPIN