Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Michael Vaughan Antoniacci

Individual provider Physician Assistant · NPI 1639050313

Michael Vaughan Antoniacci is a Physician Assistant in Scranton, Pennsylvania. Qualified in 2025, 1 year ago. Practices with Northeastern Rehabilitation Associates, PC, a 47-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Pennsylvania.

Years since qualifying
1
Licensed in
PA
In the registry since
2025
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Practice location Address checks out

5 Morgan Hwy
Scranton, PA 18508-2641
Phone: (570) 344-3788
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence MA066899 (PA)

Record details

NPI number1639050313
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 10, 2025
Last updated in NPPESSeptember 10, 2025
Certification dateSeptember 10, 2025
Mailing address5 Morgan Hwy, Scranton, PA 18508-2641

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice Northeastern Rehabilitation Associates, Pc — 47 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

Other providers in Scranton