Healthcare Provider Details

I. General information

NPI: 1700878022
Provider Name (Legal Business Name): ANTHONY J. GINGO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7215 OLD OAK BLVD STE A314
MIDDLEBURG HEIGHTS OH
44130-3340
US

IV. Provider business mailing address

7255 OLD OAK BLVD STE C112
CLEVELAND OH
44130-3329
US

V. Phone/Fax

Practice location:
  • Phone: 440-816-5333
  • Fax:
Mailing address:
  • Phone: 440-816-5333
  • Fax: 888-376-2624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35060907G
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: