Provider Demographics
NPI:1427014448
Name:NOTINO, ANTHONY G (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:G
Last Name:NOTINO
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 1:700 E MOREHEAD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 SPINDRIFT DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7800
Practice Address - Country:US
Practice Address - Phone:716-631-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2090922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00026429107OtherUNIVERA
0142862OtherGHI
NY02458051Medicaid
P010209092OtherBLUE SHIELD
000527412006OtherBLUE SHIELD WNY
4194881OtherGHI
P040209092OtherROCHESTER BLUE SHIELD
195510FFOtherPREFERRED CARE
NY2090926WOtherWORKERS COMPENSATION
1611710OtherINDEPENDENT HEALTH
P020209092OtherBLUE SHIELD ROCHESTER
000527412008OtherBLUE SHIELD WNY
000527412001OtherBLUE SHIELD WNY
200928832OtherEMPIRE
P00081480OtherRR MEDICARE
00026429101OtherUNIVERA
00026429105OtherUNIVERA
040426003197OtherFIDELIS
P00061160OtherRAILROAD MEDICARE
P010209092OtherBLUE CHOICE
4194881OtherGHI
NYDD7185Medicare PIN
RB2813Medicare PIN
P040209092OtherROCHESTER BLUE SHIELD