Provider Demographics
NPI:1477506855
Name:ANTONIONI, JANET L (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:ANTONIONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:465 WAVERLEY OAKS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-8484
Mailing Address - Country:US
Mailing Address - Phone:781-891-3706
Mailing Address - Fax:781-891-3564
Practice Address - Street 1:465 WAVERLEY OAKS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-8448
Practice Address - Country:US
Practice Address - Phone:781-891-3706
Practice Address - Fax:781-891-3564
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA817292080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110056436AMedicaid
MA110056436AMedicaid
MAA2054001Medicare PIN