Provider Demographics
NPI:1710913934
Name:ANTONIADES ORTHOPAEDICS, LLC
Entity Type:Organization
Organization Name:ANTONIADES ORTHOPAEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONIADES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-951-1773
Mailing Address - Street 1:25 BARTHEL CT
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-1528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3449 WILKENS AVE
Practice Address - Street 2:STE 107
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5281
Practice Address - Country:US
Practice Address - Phone:410-368-9992
Practice Address - Fax:410-368-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD873AANOtherBC / BS OF MD
MDJ817OtherBLUECHOICE
MD6379210001Medicare NSC
MD873AANOtherBC / BS OF MD