Provider Demographics
NPI:1265593453
Name:MAGGIO, ANTHONY RAYMOND (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:RAYMOND
Last Name:MAGGIO
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 1:7000 CHARLESTON OAKS DR N
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-2518
Mailing Address - Country:US
Mailing Address - Phone:251-634-4260
Mailing Address - Fax:
Practice Address - Street 1:2451 FILLINGIM ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-471-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.28167207P00000X, 207R00000X, 208M00000X, 208VP0000X
SC51925208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-42325OtherBCBS
AL515-97597OtherBCBS
AL009910644Medicaid
AL009910822Medicaid
AL009910862Medicaid
AL009910652Medicaid
AL009910708Medicaid
AL1265593453OtherTRICARE SOUTH
AL510-06194OtherBCBS
AL515-42324OtherBCBS
AL510-06192OtherBCBS
AL510-06196OtherBCBS
AL009910646Medicaid
AL009910646Medicaid
ALP00733098Medicare PIN
AL510-06196OtherBCBS
AL009910644Medicaid