Provider Demographics
NPI:1053332486
Name:ANTHONY, JOSEPH ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ROBERT
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 FRANKLIN ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1221
Mailing Address - Country:US
Mailing Address - Phone:203-709-8873
Mailing Address - Fax:203-709-8689
Practice Address - Street 1:56 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1221
Practice Address - Country:US
Practice Address - Phone:203-709-6360
Practice Address - Fax:203-709-5118
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT013348207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT03-70392OtherUHC
CT285606OtherUSA
CT3056407/4266599OtherAETNA
CTP2837309OtherOXFORD
CT001133488Medicaid
CT03-70392OtherAMERICHOICE
CTP00017069OtherRR MEDICARE
CT010013348CT06OtherANTHEM BCBS CT
CT2V3264OtherHEALTHNET/COMMERCIAL
CT013348OtherCONNECTICARE
CT180662OtherWELLCARE
CT001133488Medicaid
CTP00017069OtherRR MEDICARE