Provider Demographics
NPI:1376754002
Name:GANNON, ANTHONY W (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:W
Last Name:GANNON
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:1600 ROCKLAND RD
Mailing Address - Street 2:DIVISION OF PEDIATRIC ENDOCRINOLOGY
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3607
Mailing Address - Country:US
Mailing Address - Phone:302-651-5965
Mailing Address - Fax:302-651-5419
Practice Address - Street 1:1600 ROCKLAND RD
Practice Address - Street 2:DIVISION OF PEDIATRIC ENDOCRINOLOGY
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3607
Practice Address - Country:US
Practice Address - Phone:302-651-5965
Practice Address - Fax:302-651-4945
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC1-00108712080P0205X, 208000000X, 207RE0101X, 207R00000X, 2080P0205X
MS19923207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism