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ANTHONY DISTEFANO, JR MD
NPI 1063646552
Family Medicine - Adult Medicine in Worcester, MA

Active since May 12, 2009
562 LINCOLN ST, WORCESTER, MA 01605(508) 852-6028(508) 721-7821 Get Directions Write a Review

NPPES record last updated: May 12, 2009. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Anthony Distefano, Jr Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANTHONY DISTEFANO, JR MD (NPI 1063646552) is a healthcare organization registered as an adult medicine in Worcester, Massachusetts and active in the NPI registry since May 2009. The organization lists Anthony J Distefano, Owner, as its authorized official.

NPPES Registry Identity

NPI1063646552
Entity TypeOrganization
Primary Taxonomy207QA0505X
Legal Business NameANTHONY DISTEFANO, JR MD
Location Address562 LINCOLN STWorcester, MA 01605-1916
Mailing Address562 Lincoln StWorcester, MA 01605-1916 · (508) 852-6028 · Fax (508) 721-7821
Phone(508) 852-6028
Fax(508) 721-7821
Organization SubpartNo
Authorized OfficialAnthony J DistefanoOwner · (508) 852-6028
Enumeration DateMay 12, 2009
✔ NPI 1063646552 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Adult MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QA0505X
License✔ Licensed in MA · 21567
Definition
The National Uniform Claim Committee (NUCC) recommends code 207QA0505X not be used. Choose a more appropriate code.
562 LINCOLN ST, Worcester, MA 01605
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Other Identifiers 1

Medicare PINM11882MA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HUM TUM CARE
Foster Care Agency
562 LINCOLN ST
WORCESTER, MA 01605
Worcester County (978) 846-6218
ANTHONY J DISTEFANO III DDS PC
Dentist
562 LINCOLN ST
WORCESTER, MA 01605
Worcester County (508) 852-0854

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Anthony Distefano, Jr MD's NPI number?

The NPI number for Anthony Distefano, Jr MD is 1063646552. It was assigned to this organization in the NPPES registry on May 12, 2009.

Where is Anthony Distefano, Jr MD located?

Anthony Distefano, Jr MD is located at 562 Lincoln St, Worcester, MA 01605. The listed phone number is (508) 852-6028.

What is Anthony Distefano, Jr MD's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Adult Medicine, with taxonomy code 207QA0505X.

When was this NPI record last updated?

The NPPES record for Anthony Distefano, Jr MD was last updated on May 12, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.