Provider Demographics
NPI:1306916846
Name:PANTALEO, ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:PANTALEO
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 1:945 SUMMER ST FL 3
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5557
Mailing Address - Country:US
Mailing Address - Phone:203-359-2444
Mailing Address - Fax:203-359-3169
Practice Address - Street 1:945 SUMMER ST FL 3
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905
Practice Address - Country:US
Practice Address - Phone:203-359-2444
Practice Address - Fax:203-359-3169
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT42295207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT201102818OtherTAX ID
CT2V3586OtherHEALTH NET
CT010042295CT01OtherBLUE CROSS & BLUE SHIELD
CT001422956Medicaid
CT7725568OtherAETNA
CT001422956Medicaid
CT201102818OtherTAX ID