Provider Demographics
NPI:1609963370
Name:MACINO, ANTHONY
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:MACINO
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 1:3140 W SYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4133
Mailing Address - Country:US
Mailing Address - Phone:419-824-5063
Mailing Address - Fax:419-824-0216
Practice Address - Street 1:3140 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4133
Practice Address - Country:US
Practice Address - Phone:419-824-5063
Practice Address - Fax:419-824-0216
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2638186Medicaid
OH203316143002OtherMEDICAL MUTUAL OF OHIO
OH203316143002OtherMEDICAL MUTUAL OF OHIO