Provider Demographics
NPI:1639584683
Name:ANTONY, MC ANTO
Entity Type:Individual
Prefix:
First Name:MC ANTO
Middle Name:
Last Name:ANTONY
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:PO BOX 262
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-0262
Mailing Address - Country:US
Mailing Address - Phone:864-512-4160
Mailing Address - Fax:864-512-4165
Practice Address - Street 1:2000 E GREENVILLE ST STE 3100
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621
Practice Address - Country:US
Practice Address - Phone:864-512-4160
Practice Address - Fax:864-512-4165
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC819859207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program