Provider Demographics
NPI:1124036694
Name:ANTONY, ALVIN K (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:K
Last Name:ANTONY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 ZEBULON RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2426
Mailing Address - Country:US
Mailing Address - Phone:252-442-4024
Mailing Address - Fax:252-442-5056
Practice Address - Street 1:3101 ZEBULON RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2426
Practice Address - Country:US
Practice Address - Phone:252-442-4024
Practice Address - Fax:252-442-5056
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063386208100000X
NY2306951208100000X
NC2008-000052081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909282Medicaid
140405Medicare UPIN
NC2022493Medicare PIN
KK05P667Medicare PIN