MEDICARE: MR. ANTHONY DOMENIC DISABATINO

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	103TS0200X	School Psychologist		OH

General Provider Information

NPI Number	:	1841928496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY DOMENIC DISABATINO

Provider Business Mailing Address
First Line	:	815 N MAIN ST
Second Line	:
City	:	UNION
State	:	OH
Zip	:	45322-9745
Country	:	US
Telephone Number	:	937-286-7283
Fax Number	:

Provider Business Practice Location Address
First Line	:	815 N MAIN ST
Second Line	:
City	:	UNION
State	:	OH
Zip	:	45322-9745
Country	:	US
Telephone Number	:	937-286-7283
Fax Number	:

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

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	08/11/2022

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