Basic Information
| Provider Information | |||||||||
| NPI: | 1003806209 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANTHONY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 LIVINGSTON AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440523781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402331068 | ||||||||
| FaxNumber: | 4402331028 | ||||||||
| Practice Location | |||||||||
| Address1: | 1957 COOPER FOSTER PARK RD | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440011207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402331068 | ||||||||
| FaxNumber: | 4402464560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2005 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | 35045275 | OH | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | 207QS0010X | 35045275 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0487647 | 05 | OH | MEDICAID |