Provider Demographics
NPI:1194799973
Name:PATRIARCO, ANTHONY G (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:G
Last Name:PATRIARCO
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 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:911 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091-4183
Practice Address - Country:US
Practice Address - Phone:540-745-2031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044698207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA44482OtherOPTIMA
VA700028144OtherCIGNA
VA5862736OtherVA PREMIER
VA005862736Medicaid
VA148137OtherSOUTHERN HEALTH
VA231695OtherANTHEM
VA148137OtherSOUTHERN HEALTH
VA005769A75Medicare ID - Type Unspecified
VA005862736Medicaid
VA231695OtherANTHEM