Provider Demographics
NPI:1508814641
Name:ANTOSZYK, JAMES HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HOWARD
Last Name:ANTOSZYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-838-8494
Practice Address - Street 1:6035 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3256
Practice Address - Country:US
Practice Address - Phone:704-295-3000
Practice Address - Fax:704-838-8494
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-00165207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0494683003OtherCIGNA
NC0841724OtherUNITED HEALTHCARE
NC11626OtherBCBS
NC175006OtherCOVENTRY
NC21855OtherPARTNERS
NC75514OtherMEDCOST
NC8911626Medicaid
NC103936OtherWELLNESS
NC11615OtherDOCTORS HEALTH PLAN
NC376554OtherMAMSI
NC4205345OtherAETNA
SCN08204Medicaid
SC20082699OtherSELECT HEALTH OF SC/FIRST CHOICE
SC773579OtherWELLCARE
NC21855OtherPARTNERS
NC11615OtherDOCTORS HEALTH PLAN
0264730001Medicare ID - Type UnspecifiedPALMETTO
SCN08204Medicaid