Provider Demographics
NPI:1649253550
Name:DASARO, ANTHONY P (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:P
Last Name:DASARO
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 1:1401 QUINCY LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1401 QUINCY LN
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-1618
Practice Address - Country:US
Practice Address - Phone:304-415-2933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19826207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100148530Medicaid
OH3115319Medicaid
WV3810024049OtherGROUP MEDICAID
WVP00912113OtherRR MEDICARE
WV6000291000Medicaid
OH3115319Medicaid
WV6000291000Medicaid
OH3115319Medicaid
WV4201554Medicare PIN
WVB441 THSPP GROUPMedicare PIN
WV4201558Medicare PIN