Provider Demographics
NPI:1467669770
Name:ANTIPOLO, ASHLEY RAE (MD)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:RAE
Last Name:ANTIPOLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:RAE
Other - Last Name:EARLEYWINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:ARKANSAS CHILDREN'S HOSPITAL
Mailing Address - Street 2:1 CHILDREN'S WAY 653
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3591
Mailing Address - Country:US
Mailing Address - Phone:501-364-1100
Mailing Address - Fax:
Practice Address - Street 1:ARKANSAS CHILDREN'S HOSPITAL
Practice Address - Street 2:1 CHILDREN'S WAY 653
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3591
Practice Address - Country:US
Practice Address - Phone:501-364-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-6574208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5AF15Medicare PIN