Provider Demographics
NPI:1053342881
Name:ANZALONE, ANGELO ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:ANTHONY
Last Name:ANZALONE
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:RR 1 BOX 11
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-9758
Mailing Address - Country:US
Mailing Address - Phone:207-255-3356
Mailing Address - Fax:207-255-0289
Practice Address - Street 1:RR 1 BOX 11
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-9758
Practice Address - Country:US
Practice Address - Phone:207-255-3356
Practice Address - Fax:207-255-0289
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME05064207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME1572Medicare ID - Type Unspecified
MEB39955Medicare UPIN