Provider Demographics
NPI:1679577563
Name:ANTHONY, MARION DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:DEAN
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DEAN
Other - Middle Name:
Other - Last Name:ANTHONY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5575 W LAS POSITAS BLVD
Mailing Address - Street 2:STE 260
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-5803
Mailing Address - Country:US
Mailing Address - Phone:925-847-3020
Mailing Address - Fax:925-847-8933
Practice Address - Street 1:5575 W LAS POSITAS BLVD
Practice Address - Street 2:STE 260
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-5803
Practice Address - Country:US
Practice Address - Phone:925-847-3020
Practice Address - Fax:925-847-8933
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36637174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A46750Medicare UPIN
00G366370Medicare ID - Type Unspecified