Provider Demographics
NPI:1801027008
Name:ANTHONY VINCENT DITARANTO MD JD PC
Entity Type:Organization
Organization Name:ANTHONY VINCENT DITARANTO MD JD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:DITARANTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-536-4690
Mailing Address - Street 1:6031 BANBURY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-2801
Mailing Address - Country:US
Mailing Address - Phone:706-536-4690
Mailing Address - Fax:706-596-8947
Practice Address - Street 1:5131 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-4196
Practice Address - Country:US
Practice Address - Phone:706-561-1371
Practice Address - Fax:706-561-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
202G017852Medicare PIN
GA6369390001Medicare NSC