Provider Demographics
NPI:1336584564
Name:ANTHONY P. KOULIANOS MD INC
Entity Type:Organization
Organization Name:ANTHONY P. KOULIANOS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:P
Authorized Official - Last Name:KOULIANOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-953-3204
Mailing Address - Street 1:935 TRAILWOOD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5062
Mailing Address - Country:US
Mailing Address - Phone:330-953-3204
Mailing Address - Fax:330-953-3206
Practice Address - Street 1:935 TRAILWOOD DR
Practice Address - Street 2:SUITE A
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5062
Practice Address - Country:US
Practice Address - Phone:330-953-3204
Practice Address - Fax:330-953-3206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072348207VB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VB0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObesity MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2021010Medicaid
OHG67336Medicare UPIN
OH2021010Medicaid