Provider Demographics
NPI:1013245547
Name:DENISCO, ANTHONY JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOHN
Last Name:DENISCO
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:P.O. BOX 170
Mailing Address - Street 2:
Mailing Address - City:HARROD
Mailing Address - State:OH
Mailing Address - Zip Code:45850
Mailing Address - Country:US
Mailing Address - Phone:419-230-7474
Mailing Address - Fax:
Practice Address - Street 1:11333 RESERVOIR RD
Practice Address - Street 2:
Practice Address - City:HARROD
Practice Address - State:OH
Practice Address - Zip Code:45850
Practice Address - Country:US
Practice Address - Phone:419-230-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH44183207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology