Healthcare Provider Details

I. General information

NPI: 1265593453
Provider Name (Legal Business Name): ANTHONY RAYMOND MAGGIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 FILLINGIM ST
MOBILE AL
36617-2238
US

IV. Provider business mailing address

7000 CHARLESTON OAKS DR N
MOBILE AL
36695-2518
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-7000
  • Fax:
Mailing address:
  • Phone: 251-634-4260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.28167
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.28167
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD.28167
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD.28167
License Number StateAL
# 5
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number51925
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: