Healthcare Provider Details
I. General information
NPI: 1962407379
Provider Name (Legal Business Name): ANGELA MARIE FANIZZA-ORPHANOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 06/14/2005
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5400 KENNEDY AVENUE
CINCINNATI OH
45213
US
IV. Provider business mailing address
5400 KENNEDY AVENUE
CINCINNATI OH
45213
US
V. Phone/Fax
- Phone: 513-281-3400
- Fax:
- Phone: 513-281-3400
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | 5119 |
| License Number State | AK |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | 33527 |
| License Number State | AZ |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | E-4300 |
| License Number State | AR |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | 044061 |
| License Number State | CT |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | ME95593 |
| License Number State | FL |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | 036-110099 |
| License Number State | IL |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | 01039038 |
| License Number State | IN |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | 24780 |
| License Number State | KY |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | D60524 |
| License Number State | MD |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | 4301075651 |
| License Number State | MI |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | 2004034151 |
| License Number State | MO |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | 228827 |
| License Number State | NY |
| # 13 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | 35-059679F |
| License Number State | OH |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2085R0202X |
| Taxonomy | Diagnostic Radiology Physician |
| License Number | 5832 |
| License Number State | SD |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
