Basic Information
| Provider Information | |||||||||
| NPI: | 1376961821 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIVITO | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | ERNEST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6201 GREENLEIGH AVE STE 1400 | ||||||||
| Address2: | |||||||||
| City: | MIDDLE RIVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212202004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109336423 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1800 ORLEANS ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212870010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109558465 | ||||||||
| FaxNumber: | 4109550994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2014 | ||||||||
| LastUpdateDate: | 06/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | D94000 | MD | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.