Anthony Distefano, Jr MD
Family Medicine, Adult Medicine in Worcester, MA. Organization (NPI-2).
NPI number1063646552
StatusActive
Last updated in NPPESMay 12, 2009
Details
- NPI
- 1063646552
- Entity type
- Organization (NPI-2)
- Legal business name
- Anthony Distefano, Jr MD
- Organization subpart
- No
- Enumeration date
- May 12, 2009
- Last updated
- May 12, 2009
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207QA0505X | Family Medicine, Adult Medicine | 21567 | MA | Yes |
Practice location
562 Lincoln StWorcester, MA 01605-1916
Phone 508-852-6028 · Fax 508-721-7821
Mailing address
562 Lincoln StWorcester, MA 01605-1916
Phone 508-852-6028 · Fax 508-721-7821
Authorized official
Anthony J Distefano
Owner
5088526028
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