Basic Information
| Provider Information | |||||||||
| NPI: | 1922293828 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATIBANDLA | ||||||||
| FirstName: | ANITA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 SEAGATE STE 800 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436041558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912192 | ||||||||
| FaxNumber: | 4194793297 | ||||||||
| Practice Location | |||||||||
| Address1: | 2751 BAY PARK DR STE 304 | ||||||||
| Address2: | |||||||||
| City: | OREGON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436164922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1946907580 | ||||||||
| FaxNumber: | 4196977703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2007 | ||||||||
| LastUpdateDate: | 03/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 35.090715 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 9401079 | 01 | AETNA | OTHER | 000000544668 | 01 | ANTHEM | OTHER | 2794543 | 05 | OH | MEDICAID | 05249 | 01 | PARAMOUNT | OTHER | 47358 | 01 | HPM | OTHER |