Provider Demographics
NPI:1528675261
Name:DELISI, ANTHONY FRANCIS
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:FRANCIS
Last Name:DELISI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CONVERSE AVE
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-7507
Mailing Address - Country:US
Mailing Address - Phone:857-939-6245
Mailing Address - Fax:
Practice Address - Street 1:1120 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4313
Practice Address - Country:US
Practice Address - Phone:857-939-6245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist