Provider Demographics
NPI:1487283057
Name:FABIANO, ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:FABIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:FABIANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1300 FAIMOUNT AVE
Mailing Address - Street 2:APARTMENT 940
Mailing Address - City:PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:19123
Mailing Address - Country:US
Mailing Address - Phone:480-272-3377
Mailing Address - Fax:
Practice Address - Street 1:2451 GRANT AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1031
Practice Address - Country:US
Practice Address - Phone:215-439-7153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.147054207P00000X
390200000X
PAMD483232207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program