Provider Demographics
NPI:1902831043
Name:DEFELICE, ANTHONY E (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:E
Last Name:DEFELICE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:24 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-499-6600
Mailing Address - Fax:413-442-0744
Practice Address - Street 1:24 PARK STREET
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-499-6600
Practice Address - Fax:413-442-0744
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA157983207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma