Provider Demographics
NPI:1033147574
Name:D'ANTONIO, RICHARD G (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:D'ANTONIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12 BRECON PL
Mailing Address - Street 2:STE. 410
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2343
Mailing Address - Country:US
Mailing Address - Phone:410-825-3416
Mailing Address - Fax:410-296-1796
Practice Address - Street 1:12 BRECON PL
Practice Address - Street 2:STE. 410
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2343
Practice Address - Country:US
Practice Address - Phone:410-825-3416
Practice Address - Fax:410-296-1796
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD32929207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD550891600Medicaid
MD550891600Medicaid
MD2671Medicare ID - Type Unspecified