Provider Demographics
NPI:1568528768
Name:ANTONARAKIS, EMMANUEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:S
Last Name:ANTONARAKIS
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 1:1650 ORLEANS ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0013
Mailing Address - Country:US
Mailing Address - Phone:443-287-0553
Mailing Address - Fax:
Practice Address - Street 1:1650 ORLEANS ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0013
Practice Address - Country:US
Practice Address - Phone:443-287-0553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2013-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD66129207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD632101100Medicaid
MD632101100Medicaid