Provider Demographics
NPI:1811368822
Name:D'AMICO, ANTHONY (PA)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:D'AMICO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 W MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055
Mailing Address - Country:US
Mailing Address - Phone:220-564-2900
Mailing Address - Fax:220-564-2901
Practice Address - Street 1:1717 W MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055
Practice Address - Country:US
Practice Address - Phone:220-564-2900
Practice Address - Fax:220-564-2901
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004494363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant