Healthcare Provider Details

I. General information

NPI: 1790797421
Provider Name (Legal Business Name): ANTHONY VINCENT CAGGIANO SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 J CLYDE MORRIS BLVD STE 602
NEWPORT NEWS VA
23601-1929
US

IV. Provider business mailing address

1100 NW 8TH AVE SUITE B
GAINESVILLE FL
32601-2916
US

V. Phone/Fax

Practice location:
  • Phone: 757-534-5511
  • Fax: 757-534-5515
Mailing address:
  • Phone: 352-378-7544
  • Fax: 352-378-7067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME54586
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME54586
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number0101253349
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: