Healthcare Provider Details

I. General information

NPI: 1205884822
Provider Name (Legal Business Name): ANTHONY F GUANCIALE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 BLUE ASH RD
CINCINNATI OH
45242
US

IV. Provider business mailing address

PO BOX 636256 PO BOX 636256
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-792-7445
  • Fax: 513-791-4042
Mailing address:
  • Phone: 513-585-5506
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35062680G
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number3506280G
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.062680
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: