Provider Demographics
NPI:1477549061
Name:ANTIGUA, MAIDA P (MD)
Entity Type:Individual
Prefix:
First Name:MAIDA
Middle Name:P
Last Name:ANTIGUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:160 OLD DERBY ST STE 451
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4062
Mailing Address - Country:US
Mailing Address - Phone:781-980-1290
Mailing Address - Fax:781-374-7207
Practice Address - Street 1:160 OLD DERBY ST STE 451
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4062
Practice Address - Country:US
Practice Address - Phone:781-980-1290
Practice Address - Fax:781-374-7207
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA40534207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4656599-002OtherCIGNA
MAAA28536OtherHARVARD PILGRIM
MA449459OtherAETNA
MA110037459AMedicaid
MA040534OtherTUFTS HEALTH PLAN
MA110037459AMedicaid
MAM09402Medicare ID - Type Unspecified