MEDICARE: ANGELO ANTHONY ANZALONE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	05064	ME
2	207Q00000X	Family Medicine Physician	05064	ME

General Provider Information

NPI Number	:	1053342881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELO ANTHONY ANZALONE MD

Provider Business Mailing Address
First Line	:	RR 1 BOX 11
Second Line	:
City	:	MACHIAS
State	:	ME
Zip	:	04654-9758
Country	:	US
Telephone Number	:	207-255-3356
Fax Number	:	207-255-0289

Provider Business Practice Location Address
First Line	:	RR 1 BOX 11
Second Line	:
City	:	MACHIAS
State	:	ME
Zip	:	04654-9758
Country	:	US
Telephone Number	:	207-255-3356
Fax Number	:	207-255-0289

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	09/11/2025

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