Healthcare Provider Details

I. General information

NPI: 1477244754
Provider Name (Legal Business Name): ANTHONY MINETOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 BAY RIDGE AVE STE 190
ANNAPOLIS MD
21403-2834
US

IV. Provider business mailing address

1182 GATOR CT
ARNOLD MD
21012-1970
US

V. Phone/Fax

Practice location:
  • Phone: 443-281-9430
  • Fax:
Mailing address:
  • Phone: 443-534-3821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: