Provider Demographics
NPI:1215964291
Name:CONTI, ANTHONY R (DO)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:R
Last Name:CONTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 COMMONWEALTH AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923
Mailing Address - Country:US
Mailing Address - Phone:978-774-2119
Mailing Address - Fax:978-762-0511
Practice Address - Street 1:140 COMMONWEALTH AVE
Practice Address - Street 2:STE 104
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923
Practice Address - Country:US
Practice Address - Phone:978-774-2119
Practice Address - Fax:978-762-0511
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA71416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3103056Medicaid
F21402Medicare UPIN
MAJ12084Medicare ID - Type Unspecified