Provider Demographics
NPI:1386743342
Name:MEDICAL ASSOCIATES OF NEPA
Entity type:Organization
Organization Name:MEDICAL ASSOCIATES OF NEPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:YANNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-969-1904
Mailing Address - Street 1:1789 N KEYSER AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-1250
Mailing Address - Country:US
Mailing Address - Phone:570-969-1904
Mailing Address - Fax:570-969-2916
Practice Address - Street 1:1789 N KEYSER AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1250
Practice Address - Country:US
Practice Address - Phone:570-969-1904
Practice Address - Fax:570-969-2916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001817113Medicaid
PA037344Medicare ID - Type UnspecifiedGROUP