Provider Demographics
NPI:1982663753
Name:ANZILOTTI, KERT (MD)
Entity Type:Individual
Prefix:
First Name:KERT
Middle Name:
Last Name:ANZILOTTI
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 1:5936 LIMESTONE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8905
Mailing Address - Country:US
Mailing Address - Phone:302-234-5800
Mailing Address - Fax:302-234-2380
Practice Address - Street 1:5936 LIMESTONE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8905
Practice Address - Country:US
Practice Address - Phone:302-234-5800
Practice Address - Fax:302-234-2380
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00072472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000030421Medicaid
DEP00126609OtherRAILROAD MEDICARE
H40780Medicare UPIN
DE013986X70Medicare PIN
DEP00126609OtherRAILROAD MEDICARE