Provider Demographics
NPI:1588605992
Name:DELUISE, ANTHONY MICHAEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:DELUISE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:285 PROMENADE STREET
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908
Mailing Address - Country:US
Mailing Address - Phone:401-459-4001
Mailing Address - Fax:401-459-4006
Practice Address - Street 1:285 PROMENADE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-5794
Practice Address - Country:US
Practice Address - Phone:401-459-4001
Practice Address - Fax:401-459-4006
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD12362207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0014606Medicare PIN
RI001460601Medicare PIN