1205884822 NPI number — DR. ANTHONY F GUANCIALE M.D.

Table of content: DR. ANTHONY F GUANCIALE M.D. (NPI 1205884822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205884822 NPI number — DR. ANTHONY F GUANCIALE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUANCIALE
Provider First Name:
ANTHONY
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205884822
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 636256 PO BOX 636256
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-6256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-585-5506
Provider Business Mailing Address Fax Number:
513-585-5511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9250 BLUE ASH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-792-7445
Provider Business Practice Location Address Fax Number:
513-791-4042
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  35062680G , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0117X , with the licence number: 3506280G , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 35.062680 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 162201 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200051170 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64939127 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200024475 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: H164280 . This is a "MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0162201 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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