Provider Demographics
NPI:1306829239
Name:ANTHONY, ANNGENE GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNGENE
Middle Name:GRACE
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNGENE
Other - Middle Name:ANTHONY
Other - Last Name:GIUSTOZZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3001
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-0598
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:530 MAIN ST
Practice Address - Street 2:SUITE 4A
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2669
Practice Address - Country:US
Practice Address - Phone:908-879-4300
Practice Address - Fax:908-879-8956
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11471207Q00000X
NJ25MA08246800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0217417Medicaid
NJ311891Medicare PIN