Provider Demographics
NPI:1861433021
Name:CARDILLO, ANTHONY M (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:M
Last Name:CARDILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:M
Other - Last Name:CARDILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:914 N GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-2129
Mailing Address - Country:US
Mailing Address - Phone:310-488-2830
Mailing Address - Fax:888-502-9285
Practice Address - Street 1:1509 WILSON TER
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4007
Practice Address - Country:US
Practice Address - Phone:310-488-2830
Practice Address - Fax:888-502-9285
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82516207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A825160Medicaid
I37035Medicare UPIN
CAAP563YMedicare PIN
CA00A825160Medicaid