Provider Demographics
NPI:1144212176
Name:GERACI, ANTHONLY R (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONLY
Middle Name:R
Last Name:GERACI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 BRIGHAM DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-7114
Mailing Address - Country:US
Mailing Address - Phone:419-872-7703
Mailing Address - Fax:419-872-1704
Practice Address - Street 1:1601 BRIGHAM DR
Practice Address - Street 2:SUITE 120
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-7114
Practice Address - Country:US
Practice Address - Phone:419-872-7703
Practice Address - Fax:419-872-1704
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35031643207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00178OtherPARAMOUNT
OH51-5684OtherUHC
OH0127599Medicaid
OH000000346276OtherANTHEM
OH4047035OtherAETNA
OH169284769-017OtherMMO
OH0127599Medicaid
OHA71430Medicare UPIN