Provider Demographics
NPI:1790170595
Name:CASACCHIA, ANTHONY ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ROBERT
Last Name:CASACCHIA
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 1:905 SAHARA TRL
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3687
Mailing Address - Country:US
Mailing Address - Phone:330-729-8977
Mailing Address - Fax:330-729-8959
Practice Address - Street 1:905 SAHARA TRL
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3687
Practice Address - Country:US
Practice Address - Phone:330-729-8977
Practice Address - Fax:330-729-8959
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.130068207RG0300X, 207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0236867Medicaid