Individual
DR. ANTHONY JOHN DISTASIO II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 GRESHAM DR STE 204, NORFOLK, VA 23507-1904
(757) 388-5680
(757) 388-5681
Mailing address
600 GRESHAM DR STE 204, NORFOLK, VA 23507-1904
(757) 388-5680
(757) 388-5681
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
0101041449
VA
207XX0801X
Orthopaedic Trauma Physician
Primary
0101041449
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007306091
—
VA
Enumeration date
06/21/2005
Last updated
09/16/2024
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