Provider Demographics
NPI:1922293828
Name:PATIBANDLA, ANITA (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:PATIBANDLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEAGATE STE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:419-291-2192
Mailing Address - Fax:419-479-3297
Practice Address - Street 1:2751 BAY PARK DR STE 304
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4922
Practice Address - Country:US
Practice Address - Phone:194-690-7580
Practice Address - Fax:419-697-7703
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.090715207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
05249OtherPARAMOUNT
000000544668OtherANTHEM
47358OtherHPM
9401079OtherAETNA
OH2794543Medicaid
OH2794543Medicaid