Healthcare Provider Details

I. General information

NPI: 1922112481
Provider Name (Legal Business Name): ANTHONY JOHN VISALLI D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 FOREST VALLEY DR
FOREST HILL MD
21050-2831
US

IV. Provider business mailing address

19 BEECHAM CT SUITE 204
OWINGS MILLS MD
21117-6001
US

V. Phone/Fax

Practice location:
  • Phone: 410-838-0101
  • Fax: 410-893-3343
Mailing address:
  • Phone: 410-654-8602
  • Fax: 410-654-8709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number01075
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: