Provider Demographics
NPI:1578711495
Name:ANTOSH, DANIELLE D (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:D
Last Name:ANTOSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST STE 2221
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-441-5800
Mailing Address - Fax:713-791-5023
Practice Address - Street 1:6550 FANNIN ST STE 2221
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-441-5800
Practice Address - Fax:713-791-5023
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD038023207V00000X
MDD0069803207V00000X
TXP1516207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX311135301Medicaid
TX8FT386OtherBLUE CROSS BLUE SHIELD
TXP01186461OtherRR MEDICARE
TX311135301Medicaid
TXTXB158536Medicare PIN