Provider Demographics
NPI:1770579252
Name:SMALDINO, ANTHONY MICHAEL JR (DPM)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:SMALDINO
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:MICHAEL
Other - Last Name:SMALDINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:104 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-1801
Mailing Address - Country:US
Mailing Address - Phone:724-482-4192
Mailing Address - Fax:724-482-4859
Practice Address - Street 1:104 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1801
Practice Address - Country:US
Practice Address - Phone:724-482-4192
Practice Address - Fax:724-482-4859
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003064L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001078966Medicaid
PA1770579252OtherNPI
PA1770579252OtherNPI
PAT30681Medicare UPIN