Provider Demographics
NPI:1124019211
Name:ZANCANARO, ANTHONY V (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:V
Last Name:ZANCANARO
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 1:5901 TECHNOLOGY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-6013
Mailing Address - Country:US
Mailing Address - Phone:317-328-5050
Mailing Address - Fax:317-715-9965
Practice Address - Street 1:5901 TECHNOLOGY CENTER DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-6013
Practice Address - Country:US
Practice Address - Phone:317-328-5050
Practice Address - Fax:317-715-9965
Is Sole Proprietor?:No
Enumeration Date:2005-10-29
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030288A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000492371OtherANTHEM 203778927
IN067530OtherHEALTH ALLIANCE-351158723
IN000760OtherSIHO-351158723
IN300113167OtherRR MEDICARE-351158723
IN000000174085OtherANTHEM-351158723
IN100358970Medicaid
INQ0071681OtherCMOSHO351158723&352047427
IN000760OtherSIHO-351158723
INA67889Medicare UPIN