Provider Demographics
NPI:1124036017
Name:ANAGNOSTAKOS, HARRY J (DO)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:J
Last Name:ANAGNOSTAKOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33663 BAYVIEW MEDICAL DR
Mailing Address - Street 2:UNIT 2
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1663
Mailing Address - Country:US
Mailing Address - Phone:302-645-9325
Mailing Address - Fax:302-645-5214
Practice Address - Street 1:400 SAVANNAH RD
Practice Address - Street 2:SUITE B
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1499
Practice Address - Country:US
Practice Address - Phone:302-645-3555
Practice Address - Fax:302-644-3560
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC20003464207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000221803Medicaid
DE0000221803Medicaid
602188E77Medicare ID - Type Unspecified