Healthcare Provider Details

I. General information

NPI: 1790170595
Provider Name (Legal Business Name): ANTHONY ROBERT CASACCHIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 SAHARA TRL
POLAND OH
44514-3687
US

IV. Provider business mailing address

905 SAHARA TRL
POLAND OH
44514-3687
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-8977
  • Fax: 330-729-8959
Mailing address:
  • Phone: 330-729-8977
  • Fax: 330-729-8959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number35.130068
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number35.130068
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.130068
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: