Provider Demographics
NPI:1447228341
Name:VAZZANO, ANTHONY JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:VAZZANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:750 MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-2515
Mailing Address - Country:US
Mailing Address - Phone:410-526-7993
Mailing Address - Fax:410-526-5144
Practice Address - Street 1:10084 REISTERSTOWN RD STE 200B
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4096
Practice Address - Country:US
Practice Address - Phone:410-526-7993
Practice Address - Fax:410-526-5144
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0025020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB70851Medicare UPIN