Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | D0047688 | MD |
Y | 207XS0117X | Orthopaedic Spine Surgeon | D0047688 | MD |
NPI | 1265535512 |
---|---|
Provider Name | Spiro B Antoniades |
First Address | Great River, NY 11739-0626 |
Second Address | Bel Air, MD 21015-6010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 04/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
032500700 | (05) | MD |
F 482 / 001 | BLUE CHOICE (01) | MD |
LZ51/546417-06, 07, | BS / BC OF MD (01) | MD |
LZ51/546417-08, 09 | BC /BS OF MD (01) | MD |