Healthcare Provider Details

I. General information

NPI: 1487283057
Provider Name (Legal Business Name): ANTHONY FABIANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TONY FABIANO MD

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 07/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 GRANT AVE
PHILADELPHIA PA
19114-1031
US

IV. Provider business mailing address

1300 FAIMOUNT AVE APARTMENT 940
PHILADELPHIA OH
19123
US

V. Phone/Fax

Practice location:
  • Phone: 215-439-7153
  • Fax:
Mailing address:
  • Phone: 480-272-3377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.147054
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD483232
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: