NPIMap

Organization Active NPI

Anthony Distefano, Jr MD

  • Adult Medicine Physician
  • Worcester, MA
National Provider Identifier
1063646552
Registry record updated May 12, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
21567 Issued in MA
Legal business name
ANTHONY DISTEFANO, JR MD
Practice address
562 Lincoln St
Worcester, MA 01605-1916
Phone
(508) 852-6028
Fax
(508) 721-7821
NPI assigned
May 12, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Anthony J Distefano Jr., M.D.
Title
Owner
Phone
(508) 852-6028

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QA0505X 21567 MA Primary

Addresses

Primary practice location

562 Lincoln St
Worcester, MA 01605-1916

Mailing address

562 Lincoln St
Worcester, MA 01605-1916
Phone (508) 852-6028

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242086400000",
    "number": "1063646552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "562 LINCOLN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016051916",
            "telephone_number": "508-852-6028",
            "fax_number": "508-721-7821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "562 LINCOLN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016051916",
            "telephone_number": "508-852-6028",
            "fax_number": "508-721-7821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTHONY DISTEFANO, JR MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-12",
        "last_updated": "2009-05-12",
        "status": "A",
        "authorized_official_last_name": "DISTEFANO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-852-6028",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "MA",
            "license": "21567",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.