Provider Demographics
NPI:1992426894
Name:POOLE, ANTHONY J
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:POOLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 8TH ST APT A7
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:VA
Mailing Address - Zip Code:24179-4831
Mailing Address - Country:US
Mailing Address - Phone:540-595-1928
Mailing Address - Fax:
Practice Address - Street 1:220 8TH ST APT A7
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-4831
Practice Address - Country:US
Practice Address - Phone:540-595-1928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion