Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 35072348K | OH |
NPI | 1013997451 |
---|---|
Provider Name | Dr. Anthony Peter Koulianos |
First Address | Campbell, OH 44405-0216 |
Second Address | Poland, OH 44514-3688 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 01/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2021010 | (05) | OH |
G67336 | (02) | OH |