Provider Demographics
NPI:1013997451
Name:KOULIANOS, ANTHONY PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:PETER
Last Name:KOULIANOS
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 1:626 MATAWAN LANE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:OH
Mailing Address - Zip Code:44405-0216
Mailing Address - Country:US
Mailing Address - Phone:330-750-0216
Mailing Address - Fax:
Practice Address - Street 1:815 SOUTHWESTERN RUN
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3688
Practice Address - Country:US
Practice Address - Phone:330-965-9508
Practice Address - Fax:330-965-9509
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072348K207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2021010Medicaid
OH0898731Medicare PIN
OH2021010Medicaid