Healthcare Provider Details

I. General information

NPI: 1003806209
Provider Name (Legal Business Name): JAMES M ANTHONY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1957 COOPER FOSTER PARK RD
AMHERST OH
44001-1207
US

IV. Provider business mailing address

1800 LIVINGSTON AVE SUITE 200
LORAIN OH
44052-3781
US

V. Phone/Fax

Practice location:
  • Phone: 440-233-1068
  • Fax: 440-246-4560
Mailing address:
  • Phone: 440-233-1068
  • Fax: 440-233-1028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35045275
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number35045275
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: