Provider Demographics
NPI:1730175993
Name:DIGIANNANTONIO, ANTHONY FEDELE (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:FEDELE
Last Name:DIGIANNANTONIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2790 HICKORYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-4384
Mailing Address - Country:US
Mailing Address - Phone:937-339-1545
Mailing Address - Fax:937-339-7431
Practice Address - Street 1:110 S STANFIELD RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2331
Practice Address - Country:US
Practice Address - Phone:937-335-5991
Practice Address - Fax:937-440-4288
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35042619D207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0410595Medicaid
OHA84663Medicare UPIN
OHDI0470513Medicare ID - Type UnspecifiedMEDICARE