Provider Demographics
NPI:1609873413
Name:BUONANNO, ANTHONY P JR (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:P
Last Name:BUONANNO
Suffix:JR
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746722
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6722
Mailing Address - Country:US
Mailing Address - Phone:773-352-1515
Mailing Address - Fax:312-929-0373
Practice Address - Street 1:220 W CHELTEN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-3803
Practice Address - Country:US
Practice Address - Phone:215-310-7022
Practice Address - Fax:267-281-1744
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD061903L207R00000X, 208M00000X
DEC1-0026043207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG61479Medicare UPIN