Provider Demographics
NPI:1609884048
Name:LOBIANCO, ANTHONY DOMENIC (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DOMENIC
Last Name:LOBIANCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 CHRISTIAN STREET
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3947
Mailing Address - Country:US
Mailing Address - Phone:215-923-3450
Mailing Address - Fax:215-923-5871
Practice Address - Street 1:826 CHRISTIAN STREET
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19147-3947
Practice Address - Country:US
Practice Address - Phone:215-923-3450
Practice Address - Fax:215-923-5871
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS001773L207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
041379Medicare PIN
D66345Medicare UPIN