Provider Demographics
NPI:1003951591
Name:DITARANTO, ANTHONY VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:VINCENT
Last Name:DITARANTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 ENTERPRISE CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9229
Mailing Address - Country:US
Mailing Address - Phone:706-317-2226
Mailing Address - Fax:706-317-2669
Practice Address - Street 1:118 ENTERPRISE CT
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9229
Practice Address - Country:US
Practice Address - Phone:706-317-2226
Practice Address - Fax:706-317-2669
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029865208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
C55718Medicare UPIN
GA6369390001Medicare NSC
202I017852Medicare PIN
GA6370960001Medicare NSC