Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1225569551 Individual Practitioner Male Practitioner

Anthony Liccini

Pediatrics • Boise, ID

Professional Overview & Biography Verified Profile Summary

Anthony Liccini is a registered healthcare professional specializing in Pediatrics in Boise, ID. Practice services are available at 305 E JEFFERSON ST under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

305 E Jefferson St

Boise, ID 837126231

Telephone 2083450715
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Pediatrics in Boise, ID

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.8 Yrs
State Avg: 19.3 Yrs
Regional Practice Density
69 Specialists

Practicing in Boise, ID (228 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2022-08-19
Pediatrics Primary Specialty

NUCC Taxonomy Code: 208000000X

State License ID M-16632

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Pediatrics

NUCC Taxonomy Code: 208000000X

State License WA MD61058990

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Secondary Practice Locations

510 W 1st Ave

Toppenish, WA 989481564

Phone: 5098655600

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

10 Associated Practitioners
NPI 1114975802

Doctor of Medicine (M.D.)

Stephanie Marria , BSN

Nurse Practitioner - Pediatrics

NPI 1124544192

Bachelor of Science in Nursing

NPI 1134178403

Doctor of Medicine (M.D.)

NPI 1245288968

Doctor of Medicine (M.D.)

Virginia Watterson , LCSW

Social Worker - Clinical

NPI 1346586930

Licensed Clinical Social Worker

NPI 1396823985

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

19 Historical Events
📍
Updated Practice Location August 19, 2022

Registered at 305 E JEFFERSON ST, BOISE, ID 837126231 (Tel: 2083450715)

📍
Updated Business Mailing Address August 19, 2022

Registered at 190 E BANNOCK ST, BOISE, ID 837126241 (Tel: 2083818752)

📍
Updated Business Mailing Address August 21, 2020

Registered at 510 W 1ST AVE, TOPPENISH, WA 989481564 (Tel: 5098655600)

👤
Provider Name / Credentials Updated August 21, 2020

Recorded as ANTHONY LICCINI

📍
Updated Practice Location July 24, 2020

Registered at 510 W 1ST AVE, TOPPENISH, WA 989481564 (Tel: 5098655600)

📍
Updated Business Mailing Address July 24, 2020

Registered at PO BOX 190, TOPPENISH, WA 989480190 (Tel: 5098655600)

👤
Provider Name / Credentials Updated July 24, 2020

Recorded as ANTHONY LICCINI, MD

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 24, 2020

Pediatrics (License #MD61058990 in WA)

NPI Profile Active June 07, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location June 07, 2017

Registered at 4800 SAND POINT WAY NE # OC.7830, SEATTLE, WA 981053901 (Tel: 2069872525)

📍
Updated Business Mailing Address June 07, 2017

Registered at 4800 SAND POINT WAY NE # OC.7830, SEATTLE, WA 981053901 (Tel: 2069872525)

👤
Provider Name / Credentials Updated June 07, 2017

Recorded as ANTHONY LICCINI

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 07, 2017

Pediatrics (License #ML60758965 in WA)

NPI Profile Active March 27, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location March 27, 2017

Registered at 4800 SAND POINT WAY NE # OC.7830, SEATTLE, WA 981053901 (Tel: 2069872525)

📍
Updated Business Mailing Address March 27, 2017

Registered at 4800 SAND POINT WAY NE # OC.7830, SEATTLE, WA 981053901 (Tel: 2069872525)

👤
Provider Name / Credentials Updated March 27, 2017

Recorded as ANTHONY LICCINI

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) March 27, 2017

Student in an Organized Health Care Education/Training Program

🟢
Initial NPI Registration & Enumeration March 27, 2017

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1225569551
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 27, 2017
Last Update: August 19, 2022
Sole Proprietor: No

Mailing Address

190 E Bannock St

Boise, ID 837126241

Phone: 2083818752

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.