Provider Demographics
NPI:1407840408
Name:DITOMASO, ANTHONY (MD)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:DITOMASO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 ENGLEWOOD RD
Mailing Address - Street 2:STE 5
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-2756
Mailing Address - Country:US
Mailing Address - Phone:941-473-8881
Mailing Address - Fax:941-475-0801
Practice Address - Street 1:2061 ENGLEWOOD RD
Practice Address - Street 2:SUITE 5
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-1749
Practice Address - Country:US
Practice Address - Phone:941-473-8881
Practice Address - Fax:941-475-0801
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61249207RG0100X
FLME6124961249207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26613OtherBCBS
FL26613OtherBCBS
FLF99174Medicare UPIN