Provider Demographics
NPI:1689060691
Name:ANASTASIO, NICHOLAS E (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:E
Last Name:ANASTASIO
Suffix:
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 1:510 IDLEWILD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3883
Mailing Address - Country:US
Mailing Address - Phone:410-820-8226
Mailing Address - Fax:
Practice Address - Street 1:510 IDLEWILD AVE STE 200
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3883
Practice Address - Country:US
Practice Address - Phone:410-820-8226
Practice Address - Fax:410-820-8405
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0087014208100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program