Provider Demographics
NPI:1598371908
Name:PUGNALE, ANTHONY OVIDIO
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:OVIDIO
Last Name:PUGNALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E ORCHARD AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-2347
Mailing Address - Country:US
Mailing Address - Phone:937-470-2651
Mailing Address - Fax:
Practice Address - Street 1:6601 AUTUMN GLEN DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-1479
Practice Address - Country:US
Practice Address - Phone:513-728-9866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant