Provider Demographics
NPI:1861408155
Name:MILICIA, ANTHONY P (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:P
Last Name:MILICIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-3008
Mailing Address - Fax:215-707-1387
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:7TH FLOOR OUT PATIENT BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-3008
Practice Address - Fax:215-707-1387
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAM2025288E207V00000X
PAMD025289E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0053032000OtherINDEPENDENCE BLUE CROSS
PA467042OtherHIGHMARK BLUE SHIELD
PA1569008OtherAETNA HMO
PA30039504OtherKEYSTONE MERCY HEALTH
PA4328709OtherAETNA PPO
PAP00360697OtherRAILROAD MEDICARE
PA001605953Medicaid
PA4882OtherBRAVO HEALTH
PA1569008OtherAETNA HMO
PAP00360697OtherRAILROAD MEDICARE