Provider Demographics
NPI:1366432932
Name:MAIORIELLO, ANTHONY VITO (MD, MS, FAANS, FACS)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:VITO
Last Name:MAIORIELLO
Suffix:
Gender:M
Credentials:MD, MS, FAANS, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8230 WALNUT HILL LN STE 514
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4407
Mailing Address - Country:US
Mailing Address - Phone:214-345-2929
Mailing Address - Fax:214-345-2905
Practice Address - Street 1:8230 WALNUT HILL LN STE 514
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4407
Practice Address - Country:US
Practice Address - Phone:214-345-2929
Practice Address - Fax:214-345-2905
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL8424207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1429191Medicaid
TX268952YKQLMedicare PIN
IA1429191Medicaid
IAI02612Medicare UPIN