Provider Demographics
NPI:1730164740
Name:DIMARCO, ANTHONY F (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:F
Last Name:DIMARCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GEAUGA
Other - Middle Name:SLEEP
Other - Last Name:CENTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13221 RAVENNA RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024
Mailing Address - Country:US
Mailing Address - Phone:440-285-4570
Mailing Address - Fax:440-286-9594
Practice Address - Street 1:13221 RAVENNA RD
Practice Address - Street 2:SUITE 13
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024
Practice Address - Country:US
Practice Address - Phone:440-285-4570
Practice Address - Fax:440-286-9594
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040889207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0461914Medicaid
OH0461914Medicaid
OH0477312Medicare UPIN