1396784963 NPI number — DR. DENNIS M ANTHONY M.D.

Table of content: DR. DENNIS M ANTHONY M.D. (NPI 1396784963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396784963 NPI number — DR. DENNIS M ANTHONY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANTHONY
Provider First Name:
DENNIS
Provider Middle Name:
M
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:
1396784963
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5964 GOLF CLUB LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45011-8224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-893-1100
Provider Business Mailing Address Fax Number:
513-893-1128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5964 GOLF CLUB LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45011-8224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-893-1100
Provider Business Practice Location Address Fax Number:
513-893-1128
Provider Enumeration Date:
06/06/2006

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: 207R00000X , with the licence number:  35-081138 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 35-081138 , 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: 2398525 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 294482 . This is a "AMERIGROUP PROVIDER NO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7584567 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 81138 . This is a "HUMANA PROVIDER NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000332355 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 04-09744 . This is a "UNITED HEALTH CARE PN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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