Provider Demographics
NPI:1427376334
Name:ANTHONY J. VALLONE, MD, PC
Entity Type:Organization
Organization Name:ANTHONY J. VALLONE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:VALLONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-372-4325
Mailing Address - Street 1:4718 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1823
Mailing Address - Country:US
Mailing Address - Phone:203-372-4325
Mailing Address - Fax:203-374-7836
Practice Address - Street 1:4718 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1823
Practice Address - Country:US
Practice Address - Phone:203-372-4325
Practice Address - Fax:203-374-7836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT012935207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1129352Medicaid
CTB83871Medicare UPIN
CT040000083Medicare PIN