Provider Demographics
NPI:1376511782
Name:DURIG, ANTHONY (MA)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:DURIG
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3869 DARROW RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2691
Mailing Address - Country:US
Mailing Address - Phone:330-688-3552
Mailing Address - Fax:330-688-0316
Practice Address - Street 1:3869 DARROW RD
Practice Address - Street 2:SUITE 202
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2691
Practice Address - Country:US
Practice Address - Phone:330-688-3552
Practice Address - Fax:330-688-0316
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00523237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0609452Medicaid
OH0609452Medicaid