Healthcare Provider Details

I. General information

NPI: 1477539880
Provider Name (Legal Business Name): ANTHONY ALTINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 HOFFNER AVE
ORLANDO FL
32812-2432
US

IV. Provider business mailing address

PO BOX 616788
ORLANDO FL
32861-6788
US

V. Phone/Fax

Practice location:
  • Phone: 407-856-1900
  • Fax: 407-856-2389
Mailing address:
  • Phone: 407-856-1900
  • Fax: 407-856-2389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME76674
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: