Basic Information
| Provider Information | |||||||||
| NPI: | 1366443590 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLAREY | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | GUY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2146 SOUTHGATE PARKWAY CAMBRIDGE VA CLINIC | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404321963 | ||||||||
| FaxNumber: | 7404350713 | ||||||||
| Practice Location | |||||||||
| Address1: | 2146 SOUTHGATE PARKWAY CAMBRIDGE VA CLINIC | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404321963 | ||||||||
| FaxNumber: | 7404350713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 03/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34-007149 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2155877 | 05 | OH | MEDICAID |