Basic Information
| Provider Information | |||||||||
| NPI: | 1205884822 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUANCIALE | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636256 PO BOX 636256 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452636256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135855506 | ||||||||
| FaxNumber: | 5135855511 | ||||||||
| Practice Location | |||||||||
| Address1: | 9250 BLUE ASH RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137927445 | ||||||||
| FaxNumber: | 5137914042 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 12/05/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 35062680G | OH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0117X | 3506280G | OH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207X00000X | 35.062680 | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 162201 | 05 | OH | MEDICAID | 200051170 | 05 | IN | MEDICAID | 64939127 | 05 | KY | MEDICAID | 200024475 | 01 | OH | RAILROAD MEDICARE | OTHER | H164280 | 01 | OH | MEDICARE | OTHER | 0162201 | 05 | OH | MEDICAID |