Provider Demographics
NPI:1104878388
Name:BROGLIO, ANTHONY LEE (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:LEE
Last Name:BROGLIO
Suffix:
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 1:822 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3718
Mailing Address - Country:US
Mailing Address - Phone:423-246-6251
Mailing Address - Fax:423-246-7230
Practice Address - Street 1:822 BROAD ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3718
Practice Address - Country:US
Practice Address - Phone:423-246-6251
Practice Address - Fax:423-246-7230
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN010808208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0213340004OtherDMERC
62086999803OtherJOHN DEERE
VA043070OtherANTHEM
VA007574258Medicaid
TN2003575OtherBLUECROSS BLUESHIELD
340011817Medicare ID - Type UnspecifiedRAILROAD
B59353Medicare UPIN
VA007574258Medicaid