Provider Demographics
NPI:1730306267
Name:GAETA, S ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:S
Middle Name:ANTHONY
Last Name:GAETA
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 1:106 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1135
Mailing Address - Country:US
Mailing Address - Phone:614-760-7425
Mailing Address - Fax:614-760-7426
Practice Address - Street 1:106 S HIGH ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1135
Practice Address - Country:US
Practice Address - Phone:614-760-7425
Practice Address - Fax:614-760-7426
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0786510Medicaid
OH0786510Medicaid