Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | OT015459 | PA |
N | 111NI0900X | Internist | OT015459 | PA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | OL60463713 | WA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | OP60569916 | WA |
Y | 2081P2900X | Pain Medicine | 186251 | OR |
N | 2081P2900X | Pain Medicine | 20A15226 | CA |
NPI | 1356781835 |
---|---|
Provider Name | Anthony Digirolamo |
First Address | Sacramento, CA 95817-2307 |
Second Address | Bend, OR 97701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2013 |
Last Update Date | 01/08/2018 |