Provider Demographics
NPI:1750353348
Name:DESALVO, ANTHONY THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:THOMAS
Last Name:DESALVO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 MIDDLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-5019
Mailing Address - Country:US
Mailing Address - Phone:865-446-9125
Mailing Address - Fax:
Practice Address - Street 1:710 MIDDLE CREEK RD
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5019
Practice Address - Country:US
Practice Address - Phone:865-446-9125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-9727207RH0003X
CO45015207RH0003X
VA0101236232207RX0202X
TN38458207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1750353348Medicaid
VAP01632648OtherRAILROAD MEDICARE
TNQ032994Medicaid
F47233Medicare UPIN