Provider Demographics
NPI:1922112481
Name:VISALLI, ANTHONY JOHN (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOHN
Last Name:VISALLI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:19 BEECHAM CT
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6001
Mailing Address - Country:US
Mailing Address - Phone:410-654-8602
Mailing Address - Fax:410-654-8709
Practice Address - Street 1:109 FOREST VALLEY DR
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2831
Practice Address - Country:US
Practice Address - Phone:410-838-0101
Practice Address - Fax:410-893-3343
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01075213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD020188000Medicaid
MD961L536EMedicare ID - Type UnspecifiedPODIATRY
T92942Medicare UPIN