Healthcare Provider Details

I. General information

NPI: 1558308270
Provider Name (Legal Business Name): DOUGLAS C ANTHONY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST APC BUILDING, 12-106
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST APC BUILDING, 12-106
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-5011
  • Fax: 401-444-8514
Mailing address:
  • Phone: 401-444-5011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number2002000486
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number2002000486
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberMD13805
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2002000486
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD13805
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: