Provider Demographics
NPI:1902098924
Name:DINOVO, ANTHONY AUGUSTINE (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:AUGUSTINE
Last Name:DINOVO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 AUTUMN CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7126
Mailing Address - Country:US
Mailing Address - Phone:281-755-5048
Mailing Address - Fax:
Practice Address - Street 1:3223 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4501
Practice Address - Country:US
Practice Address - Phone:281-485-9034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2327261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
G48869OtherUPIN
00199HMedicare PIN