Provider Demographics
NPI:1073535191
Name:FROGAMENI, ANTHONY III (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:FROGAMENI
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7887 OLD SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-4434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2865 N REYNOLDS RD
Practice Address - Street 2:SUITE 160
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2068
Practice Address - Country:US
Practice Address - Phone:419-578-7200
Practice Address - Fax:419-537-5600
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057937207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0868959Medicaid
OH0868959Medicaid
OHF25568Medicare UPIN
OH4754190005Medicare NSC
OHFR0715256Medicare PIN