Basic Information
| Provider Information | |||||||||
| NPI: | 1053332486 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANTHONY | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 56 FRANKLIN ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067061221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037098873 | ||||||||
| FaxNumber: | 2037098689 | ||||||||
| Practice Location | |||||||||
| Address1: | 56 FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067061221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037096360 | ||||||||
| FaxNumber: | 2037095118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 07/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 013348 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 03-70392 | 01 | CT | UHC | OTHER | 285606 | 01 | CT | USA | OTHER | 3056407/4266599 | 01 | CT | AETNA | OTHER | P2837309 | 01 | CT | OXFORD | OTHER | 001133488 | 05 | CT | MEDICAID | 03-70392 | 01 | CT | AMERICHOICE | OTHER | P00017069 | 01 | CT | RR MEDICARE | OTHER | 010013348CT06 | 01 | CT | ANTHEM BCBS CT | OTHER | 2V3264 | 01 | CT | HEALTHNET/COMMERCIAL | OTHER | 013348 | 01 | CT | CONNECTICARE | OTHER | 180662 | 01 | CT | WELLCARE | OTHER |