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General NPI Number Information
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NPI Number | 1700389087
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Entity Type | Individual
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Provider Name | ANTHONY CHRISTOPHER DAMICO DO
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Gender | Male
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 1100 WILFORD HALL LOOP BLDG 4554
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City | JBSA LACKLAND
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State | TX
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Zip | 78236-5638
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Country | US
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Telephone | 210-292-6255
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Fax | 210-292-7934
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Provider Business Mailing Address
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Address Line | 367 ORANGE ST APT 631
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City | NEW HAVEN
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State | CT
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Zip | 06511-6464
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Country | US
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Telephone | 630-770-7240
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 77511
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License Number State | CT
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