Healthcare Provider Details

I. General information

NPI: 1336584564
Provider Name (Legal Business Name): ANTHONY P. KOULIANOS MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 06/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 TRAILWOOD DR SUITE A
YOUNGSTOWN OH
44512-5062
US

IV. Provider business mailing address

935 TRAILWOOD DR SUITE A
YOUNGSTOWN OH
44512-5062
US

V. Phone/Fax

Practice location:
  • Phone: 330-953-3204
  • Fax: 330-953-3206
Mailing address:
  • Phone: 330-953-3204
  • Fax: 330-953-3206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License Number35072348
License Number StateOH

VIII. Authorized Official

Name: DR. ANTHONY P KOULIANOS
Title or Position: OWNER
Credential: M.D.
Phone: 330-953-3204