Provider Demographics
NPI:1598714388
Name:BACEVICE, ANTHONY E JR (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:E
Last Name:BACEVICE
Suffix:JR
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 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-988-6884
Mailing Address - Fax:440-988-6896
Practice Address - Street 1:1997 HEALTHWAY DR
Practice Address - Street 2:SUITE 203
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-2834
Practice Address - Country:US
Practice Address - Phone:440-988-6884
Practice Address - Fax:440-988-6896
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047772207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000324004OtherANTHEM BC&BS
OH0602806Medicaid
A16793Medicare UPIN
OH000000324004OtherANTHEM BC&BS
OH0602806Medicaid
OH0594908Medicare PIN